Aspectos Morfológicos de la Mama. Una Revisión de la Literatura / Morphological Aspects of the Breast. A Literature Review

La glándula mamaria tiene su origen embriológico, posteriormente se diferencia histológica y anatómicamente; a lo largo del tiempo se han ido descubriendo nuevos hallazgos, además de nueva terminología. El objetivo de este trabajo consistió en describir la actualización en los aspectos morfológicos de la glándula mamaria. Se realizó una búsqueda de artículos en diferentes fuentes primarias y secundarias de la literatura científica como: Pubmed, Embase, WOS, Scopus, Scielo obteniendo 623 publicaciones, seleccionado 53 para su revisión y 17 incluidos. La mama se ha ido actualizando en los aspectos morfológicos; Los conductos se ubican cercanos a la areola y al pezón donde desembocan directamente, las ramificaciones de los conductos se ubican cercanos a la areola; los pezones tienen entre 15 y 20 lóbulos, de los cuales sólo 5-9 son verdaderos orificios del conducto mamario, no existen senos lactíferos por lo que la leche desemboca directamente en el pezón, en cuanto a la inervación de la mama son inervados por las ramas cutáneas anterior y lateral de los nervios intercostales. La evidencia existente demuestra la necesidad de realizar estudios permanentes en el ámbito de la morfología, como fue descrito en este artículo de revisión sobre la mama. En diferentes aspectos, tales como términos, funciones y estructuras. Está información es importante para, la formación de pregrado, post grado, y su utilización en la clínica, identificación de patologías, clínicas de lactancia, entre otros.

SUMMARY: The mammary gland has its embryological origin, later it differentiates histologically and anatomically; over time new findings have been discovered, as well as new terminology. The aim of this work was to describe the update on the morphological aspects of the mammary gland. A search for articles was carried out in different primary and secondary sources of scientific literature such as: Pubmed, Embase, WOS, Scopus, Scielo, obtaining 623 publications, 53 selected for review and 17 included. The breast has been updated in morphological aspects; the ducts are located close to the areola and the nipple where they open directly, the branches of the ducts are located close to the areola; the nipples have between 15 and 20 lobes, of which only 5- 9 are true mammary duct orifices, there are no lactiferous sinuses, so the milk flows directly into the nipple, in terms of innervation of the breast they are innervated by the anterior and lateral cutaneous branches of the intercostal nerves. The existing evidence demonstrates the need for permanent studies in the field of morphology, as described in this review article on the breast. In different aspects, such as terms, functions and structures. This information is important for undergraduate and postgraduate training, and its use in the clinic, identification of pathologies, lactation clinics, among others.

Development of a software for radiological breast mammography anatomy and technical procedures study / Desenvolvimento de un software para estudio de anatomia y procedimientos técnicos en mamografia radiológica de mama

The aim of this study was to develop a software for radiological breast mammography anatomy study. A descriptive and exploratory study was carried out using mammography images database. The software was created using well-known open source image J software. Eight mammographic images were selected including standard views: craniocaudal (CC) and mediolateral oblique (MLO) views, and supplementary views. The software was created as an image J plugin-in. The virtual environment presented multiple choice questions related to radiological breast anatomy and patient positioning criteria. The software launches by requiring the user to register their profile ( user ID) followed by the selection of mammography projection technique. As the second step, a screen with multiple choice questions opens according to the technique selected by the user. At the end of the evaluation, a report is presented containing date and time of evaluation, username and the score achieved. The report also provide feedback to the user and highlight where the user incorrectly identified the anatomy. The software allowed assist on multifactor mammography learning process for radiographers. However, It is necessary the improvement of software including high quality images and case study.

El objetivo de este estudio fue de el desarrollo de un software para estudio de anatomía y procedimientos en mamografía de mama. Se realizó un estudio descriptivo y exploratorio utilizando una base de datos de imágenes mamográficas. La aplicación se creó utilizando un conocido software (imagen J) de código abierto. Se seleccionaron ocho imágenes mamográficas que incluían proyecciones estándar: proyecciones craneocaudal (CC) y mediolateral oblicua (MLO) y proyecciones complementarias. El software fue creado como un complemento de imagen J. El entorno virtual presentó preguntas de múltiple opción relacionadas con la anatomía radiológica de la mama y los criterios de posicionamiento del paciente. El software se inicia solicitando al usuario que registre su perfil (ID de usuario) seguido de la selección de la técnica de proyección de mamografía. Como segundo paso, se abre una pantalla con preguntas de opción múltiple según la técnica seleccionada por el usuario. Al final de la evaluación, se presenta un informe que contiene la fecha y hora de la evaluación, el nombre de usuario y la puntuación obtenida. El informe también proporciona comentarios al usuario y destaca dónde el usuario identificó incorrectamente la anatomía. El software permitió asistir en el proceso de aprendizaje de mamografías multifactoriales para radiólogos. Sin embargo lo és necesaria la mejora del software, incluidas imágenes de alta calidad y estudios de casos.

Toward the first definition of taste rosea in female breasts: histological analysis / La primera definición del sabor rosea en mamas femeninas: análisis histológico

Although various neuropsychochemical theories have been established about why breastfeeding mothers feel hedonic sensation, the underlying neural mechanism has not been adequately clarified. We aimed to investigate if there is hedonic sensation-initiated taste-bud like structures stimulated by sugars in the milk-secreting lactiferous ducts of mammary glands of breastfeeding female rats. In this study, twenty-two female rats were chosen which six of the virgin (n=6), six of pregnant (n=6) and ten of breastfeeding (n=10). We examined lactiferous ducts/nipples of mammary glands of all animals. They were sacrificed following intracardiac formalin injection, and their breast tissues were removed with covering tissues and fixed with 10 % of formalin solution. After current histological procedures, the tissues were examined by light microscope to assess taste-bud like structures, and their numerical densities were calculated by using stereological methods. Results were analyzed statistically. Taste-buds like structures with neuron-like appendages at the apical ends were discovered in lactiferous ducts. The taste rosea numbers were estimated as 3±1/mm3 in virgins, 167±27/mm3 in pregnant and 375±63/mm3 in breastfeeding animals. The taste rosea numbers were greater in breastfeeding rats than those of virgins and pregnant rats. They named as taste rosea resembling flower bucket which has not been mentioned in the literature so far.

Existen varias teorías neuropsicoquímicas, referente a la sensación hedónica que sienten las mujeres al amamantar, y el mecanismo neural subyacente. No obstante, estas aún no se aclaran adecuadamente. El objetivo de este estudio, fue investigar si existen estructuras hedónicas iniciadas por la sensación gustativa estimuladas por los azúcares en los conductos mamarios secretores de leche, de las glándulas mamarias de las ratas durante el período de lactancia. En este estudio, se eligieron 22 ratas hembras, seis de estas no preñadas como grupo control, seis preñadas y diez en período de lactancia. Examinamos los conductos lactíferos / pezones de las glándulas mamarias de los tres grupos. Los animales fueron sacrificados por medio de inyección intracardíaca de formalina. El tejido mamario se fijó en solución de formalina al 10 %. La muestras histólogicas fueron examinadas a través microscopía óptica con la finalidad de evaluar estructuras con características morfológicas similares a las papilas gustativas. Su densidad de número se calculó utilizando métodos estereológicos. Los resultados fueron analizados estadísticamente. En los conductos mamarios se observaron dos estructuras con con características morfológicas tipo papilas gustativas con apéndices neuronales en los extremos apicales. Los números se estimaron en 3±1/mm3 en el grupo control, 167±27/mm3 en gestantes y 375±63/mm3 en animales lactantes. El número de estructuras características morfológicas similares a las papilas gustativas fue mayor en las ratas amamantando que en el grupo control y que en las ratas preñadas. Conocido como sabor rosea debido a que se asemeja a un ramo de flores, lo que hasta ahora no se ha mencionado en la literatura.

Ptosis mamaria y su resolución quirúrgica / Breast ptosis and surgical resolution

La ptosis mamaria es una anomalía de la mama relativamente frecuente, que se debe resolver con reconstrucción quirúrgica. Los objetivos de la reconstrucción quirúrgica de esta anomalía son dos: fundamentalmente corregir la posición inestética de la mama, y en segundo plano darle consorte al posible déficit funcional que pueda presentar En general, los déficits funcionales son tratados inmediatamente, mientras que la reparación cosmética puede dividirse en dos momentos vitales del paciente; el final de la pubertad en aquellos casos vinculados al crecimiento excesivo de la glándula y consecuente pérdida de posicionamiento adecuado del CAP para alcanzar la simetría máxima posible después de la maduración completa de la mama con la reducción pertinente de la glándula, o bien según la solicitud del paciente adulto que busca recuperar la imagen estética personal perdida con el curso de los años a partir de la atrofia glandular o elongación excesiva de los tejidos.

Mammary ptosis is a relatively frequent breast anomaly, which must be resolved with surgical reconstruction. The objectives of the surgical reconstruction of this anomaly are two: fundamentally correct the unstatic position of the breast, and in the background give consolation to the possible functional deficit that may present. In general, functional deficits are treated immediately, while cosmetic repair can be divided into two vital moments of the patient; the end of puberty in those cases related to the excessive growth of the gland and consequent loss of adequate positioning of the CAP to reach the maximum possible symmetry after the complete maturation of the breast with the relevant reduction of the gland, or according to the request of the adult patient who seek store cover the lost personal aesthetic image over the years from glandular atrophy or excessive tissue elongation

Inervação do complexo areolopapilar após mamoplastia redutora: estudo histológico / Innervation of the nipple-areolar complex after reduction mammaplasty: a histological study

Introdução: A manobra de liberação dérmica periareolar na mamoplastia promove uma melhor mobilidade do complexo mamilo-aréola (NAC). No entanto, existem dúvidas sobre possíveis danos nos nervos neste tipo de topografia. Este estudo objetiva uma análise quantitativa comparando a densidade dos nervos do fluxo lateral medial, lateral e caudal do NAC. Métodos: Trata-se de um estudo prospectivo. O estudo incluiu 26 pacientes do sexo feminino que foram submetidas à mamoplastia redutora pela técnica clássica de Pitanguy. Os fragmentos da derme coletados dos lados medial, lateral e caudal foram devidamente preparados e submetidos a um estudo histológico para determinar a densidade dos nervos em cada um dos lados estudados. Resultados: Dos 26 pacientes estudados, 42,3% apresentaram maior densidade de nervos no lado lateral; 38,5%, do lado medial e 19,2% do lado caudal. A análise estatística utilizada para avaliar se houve predominância de um lado onde a derme foi seccionada demonstrou que o teste de comparação de proporções não foi significativo (p = 0,304). Conclusão: A análise comparativa mostrou que não há preponderância de densidade de nervos em qualquer lado da derme periareolar.

Introduction: The periareolar dermal release maneuver in mammoplasty promotes better mobility of the nipple-areola complex. However, there are doubts on possible nerve damages in this kind of topography. This quantitative analysis compared the nerve branches density from the medial, lateral and caudal side-flow of the nipple-areola complex (NAC). Methods: This was a prospective study. The study included 26 women who have undergone a mammaplasty reduction using the Pitanguy's classic technique. The dermis fragments collected from the medial, lateral and caudal sides were properly prepared and subjected to a histological study in order to determine the nerve branches density in each studied sides. Results: Of 26 studied patients, 42.3% had a higher nerve branches density in the lateral side; 38.5%, on the medial side and 19.2% on the caudal side. The statistical analysis used to evaluate whether there was a predominance of one side where the dermis has been sectioned showed that the proportion comparison test was not significant (p = 0.304). Conclusion: The comparative analysis has shown that there is no preponderance of nerve density in any periareolar dermis side.

Acompanhamento fonoaudiológico do aleitamento materno em recém-nascidos nas primeiras horas de vida / Speech-language therapy follow-up of breastfeeding in newborns in the first hours of life

RESUMO Introdução A fonoaudiologia tem assumido importante papel junto ao aleitamento materno. Objetivo Verificar a situação do aleitamento materno, considerando aspectos da díade mãe-recém-nascido, de acordo com tempo de vida do recém-nascido, mediante intervenção fonoaudiológica. Métodos Estudo realizado de maio de 2015 a setembro de 2016, com 166 díades mãe-recém-nascido, durante a situação do aleitamento materno, em uma maternidade pública de alto risco do estado de Sergipe. Foi utilizado protocolo específico, registrando-se aspectos anatômicos de bicos e mamas maternos, estado comportamental, padrão de pega e sucção dos recém-nascidos e postura das díades, para descrever a situação de aleitamento materno, nos três diferentes momentos: Momento 1 (linha de base); Momento 2 (intervenção fonoaudiológica); Momento 3 (acompanhamento). As análises foram descritas por meio de frequências simples e percentuais, utilizando o teste de Mantel-Haenzsel (M-H) e o teste da razão de verossimilhança (TRV), adotando nível de significância de 5%. Resultados Em relação ao efeito da intervenção fonoaudiológica, houve diferença significativa quanto aos parâmetros maternos, para situação das mamas (ingurgitamento). Nos parâmetros envolvendo os recém-nascidos, houve diferenças significativas, com melhora no padrão de pega, quanto aos seguintes aspectos: não abocanha somente o bico, abocanha parte da aréola, pega efetiva e consegue manter a pega. Quanto aos aspectos posturais da díade, houve diferenças significativas quanto à cabeça do recém-nascido elevada e alinhada e ao contato corporal ("barriga com barriga"). Conclusão A intervenção fonoaudiológica junto às díades mães-recém-nascidos, logo nas primeiras horas pós-parto, evidenciou melhora nos parâmetros considerados fundamentais para o sucesso da amamentação, vislumbrando uma prática de educação em saúde junto às puérperas.

ABSTRACT Introduction Speech therapy has assumed an important role with breastfeeding. Purpose To verify the breastfeeding situation, considering aspects of the mother-newborn dyad, according to newborn's lifetime through speech-language intervention. Methods Study conducted from May 2015 to September 2016, with 166 mother-newborn dyads during the breastfeeding situation, in a high-risk public maternity hospital in the state of Sergipe. A specific protocol was used registering anatomical aspects of nipples and breasts, newborn's behavioral status, newborn suckling and breast-latch pattern and dyads posture to describe the breastfeeding situation at different times: Moment 1 (Baseline); Moment 2 (Speech-Language Intervention); Moment 3 (Accompaniment). The results were described using simple and percentage frequencies, Mantel-Haenzsel Test (M-H) and the Likelihood Ratio Test (LRT), adopting significance level of 5%. Results Regarding the effect of the speech-language intervention, there was a significant difference in the maternal parameters for the breasts situation (regorgement); While in the parameters involving the newborns there were significant differences, with improvement in breast-latch patterns aspects such as: do not only pick up the beak, snatch part of the areola, breast-latcheffectively and manage to keep breast-latchpattern. Regarding the dyad postural aspects, there were significant differences regarding newborn's raised andaligned head and body contact (belly-to-belly). Conclusion Speech-language intervention with the mother-newborn dyads in the first hours after delivery showed an improvement in the parameters considered fundamental on a successful breastfeeding glimpsing a health education practice among the puerperal women.

Awareness and current knowledge of breast cancer

Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.

Anatomy of the lymphatic drainage of the upper limb and breast and its role in lymphedema prevention after breast cancer treatment / Anatomía del drenaje linfático del miembro superior y de la mama y su papel en la prevención del linfedema después del tratamiento del cáncer de mama

The surgical treatment of breast cancer has been enhanced throughout the years in order to offer oncologically safer and more effective results with lower esthetic impact and fewer sequelae. The lymphedema of the upper limb is still an iatrogenic result of great incidence and morbidity after this treatment. A possible existence of independent breast and upper limb lymphatic pathways has become the issue of many researchers willing to minimize its occurrence. This review aims to compare the lymphatic pathways in the axilla described by traditional anatomy books and recently published articles about Axillary Reverse Mapping (ARM). With this purpose, a comparative table was made with the descriptions found in books and articles, a statistic table of the data collected, a flowchart of anastomoses among nodes and an analytical drawing of the most statistically mentioned drained areas. It was observed that there is great variability in the descriptions of drainage and anastomoses among the lymph nodes in the references used, so there should be a consensus of a universal description which also assembles possible anatomical variations. Furthermore, the findings brought about by recent studies show possible anastomoses among pathways and lymph nodes, however they have not been taken into consideration when ARM was initially proposed. Therefore, the axillary resection with the preservation of the posterior and lateral axillary lymph nodes is theoretically possible to avoid lymphedema of the upper limb, but the development of an updated universal description that involves all possible anatomical variations will provide a safer and more effective treatment.

El tratamiento quirúrgico del cáncer de mama ha mejorado a lo largo de los años con el fin de ofrecer resultados oncológicamente más seguros y eficaces con menor impacto estético y menos secuelas. El linfedema del miembro superior es todavía un resultado iatrogénico de gran incidencia y morbilidad después de este tratamiento. La posible existencia de vías linfáticas de mama y de los miembros superiores independientes se ha convertido en un tema central de muchas investigaciones para lograr minimizar su ocurrencia. Esta revisión tiene como objetivo comparar las vías linfáticas en la axila descritas en los libros de anatomía tradicionales con artículos recientemente publicados sobre Mapeo Reverso Axilar (MRA). Con este fin, se realizó un cuadro comparativo con las descripciones y un diagrama de flujo de las anastomosis entre los nodos, además de un dibujo analítico de las áreas drenadas estadísticamente más mencionadas. Se observó que existe una gran variabilidad en las descripciones sobre el drenaje y las anastomosis entre los nodos linfáticos, por lo que la descripción universal no debería ser considerada un consenso debido a que también presenta posibles variaciones anatómicas. Por otra parte, los resultados producidos por los estudios recientes muestran posibles anastomosis entre las vías y los nodos linfáticos, sin embargo, no se han tomado en consideración cuando se propuso inicialmente el MRA. Por lo tanto, la resección axilar con la preservación de la parte posterior y los nodos linfáticos axilares laterales es teóricamente posible para evitar el linfedema del miembro superior, pero el desarrollo de una descripción universal actualizada, que incluya todas las posibles variaciones anatómicas, proporcionará un tratamiento más seguro y eficaz.

Calcificaciones mamarias: descripción y clasificación según la 5ª edición BI-RADS / Breast calcifications: description and classification according to BI-RADS 5th edition

Abstract. Breast calcifications are frequent findings in mammography. Most of them have a benign origin, such as in the case of the response to inflammatory disease of the ducts or coarse calcifications in benign nodules. Many of these calcifications show a characteristic benign appearance, and they do not need to be magnified or monitored. However, other calcifications can show a grouped pattern, have a suspicious appearance, and transform into an in situ ductal carcinoma or a high risk breast lesion. It is important to know the morphological and distribution patterns of these calcifications in order to make right decisions for each case. In the 5th edition of the BI-RADS atlas, 2013, categories and levels of suspicion for some patterns were modified. The objective of this article is to update descriptors and categories of BI-RADS micro-calcifications, pointing out their most important features and malignancy risk linked to each descriptor.

Resumen. Las calcificaciones mamarias son un hallazgo frecuente en mamografía. La mayoría de ellas tienen un origen benigno, como puede ser la respuesta a patología inflamatoria de los conductos o calcificaciones gruesas en nódulos benignos. Muchas de estas calcificaciones presentan un aspecto benigno característico y no requieren ser magnificadas o controladas. Otras calcificaciones sin embargo pueden presentarse agrupadas, tener un aspecto sospechoso y originarse en un carcinoma ductal in situ o una lesión de alto riesgo. Es relevante conocer los patrones morfológicos y de distribución de estas calcificaciones a fin de tomar la conducta adecuada para cada caso. En la 5.ª edición del atlas BI-RADS, 2013, las categorías y grados de sospecha de algunos patrones fueron modificados. El objetivo del presente artículo es realizar una actualización de los descriptores y las categorías BI-RADS de las microcalcificaciones, señalando sus características más importantes y el riesgo de malignidad asociado a cada descriptor.

Comparação entre implantes anatômicos e redondos por via periareolar em aumentos mamários primários / Comparison of anatomic and round implants using periareolar access in primary breast augmentation

INTRODUÇÃO: Aumentos mamários exigem planejamento com critérios objetivos e rigorosos, que foram padronizados pelo sistema High Five, de Tebbetts. Existe um grande número de combinações possíveis, entre via de acesso, plano e tipo de implante, o que permite proporcionar o melhor resultado para cada paciente. MÉTODO: 100 pacientes operadas, 30 com implantes anatômicos e 70 com redondos, por via retromuscular ou subglandular, com a realização de roundblock ou não. Todos os casos foram operados pela via periareolar. A avaliação pré-operatória foi realizada conforme a sistematização High Five. RESULTADOS: Roundblock foi mais utilizado no grupo de implantes anatômicos, representando 43% da amostra neste caso. O plano subglandular foi o mais utilizado, representando 76,6% da amostra total. Com relação ao implante anatômico, 86,7% dos implantes foram colocados no plano subglandular. Dos anatômicos, 71,4% foram colocados no plano subglandular. Ocorreram quatro casos de contratura capsular graus III e IV, mais comum com o uso de implante redondo. O índice de rotação do implante anatômico foi de 10%, com três casos no total. CONCLUSÃO: Ocorreu baixo índice de complicações, em conformidade com a incidência da literatura. O acesso periareolar proporcionou bons resultados em todos os casos. O paciente deve ser informado sobre a possibilidade da rotação do implante anatômico.

INTRODUCTION: Breast augmentation requires planning with objective and rigorous criteria, which were standardized by the High Five system of Tebbetts. There are a many possible combinations based on access route, implant plane, and type of implant, enabling the best outcome for each patient. METHOD: Of 100 patients studied, 30 received anatomic implants and 70 received round implants in the retromuscular or subglandular position, with or without round block technique. All cases used periareolar access. Preoperative evaluation was performed according to the High Five system. RESULTS: The round block technique was used more often with anatomic implants (43%). The subglandular plane was most commonly used (76.6%). Of 30 anatomic implants, 86.7% were placed in the subglandular plane. Of 70 round implants, 71.4% were placed in the subglandular plane. There were 4 cases of grade III and IV capsular contracture, which is more common with the use of round implants. The rate of rotation among anatomic implants was 10%, with 3 cases. CONCLUSION: There was a low complication rate, in accordance with published data. Periareolar access provided good results in all cases. The patient should be informed about the possibility of rotation with use of anatomic implants.

Photographs for anthropometric measurements of the breast region. Are there limitations?

PURPOSE: To determine the limitations of the photographs used to obtain the anthropometric measurements of the breast region. METHODS: Five women, between the ages of 18 to 60 years, were evaluated. Photographs of the frontal and left and right profile views of their breasts were taken. Based on the current literature, the most commonly used anthropometric and anatomic landmarks for breast measurement were marked in their different positions. The different points were used to evaluate if the direct anthropometry was possible in a standardized way and determine how the points and the positions can to be used in any breast measurements. RESULTS: There were some limitations to the use of defining points of the breast fold, as well as of its lower portion and lateral extension positions in both profiles. CONCLUSION: The defining points of the breast fold and the profile photographs have some limitations and we suggested how the points and positions can be used for breasts measurements. .

Implante mamário redondo versus anatômico: algoritmo para escolha da forma adequada / Round versus anatomical breast implants: algorithm for choosing the appropriate form

INTRODUÇÃO: Vários cirurgiões têm suas próprias fórmulas ou protocolos para selecionar os volumes e formato de implantes mamários. Para determinar a escolha do formato, medimos as distâncias entre a borda superior da mama e a papila (A) e entre a papila e sulco submamário (B). Baseados nestas medidas, propomos um algoritmo para selecionar próteses redondas ou anatômicas. MÉTODOS: As avaliações pré-operatórias foram realizadas com a paciente em posição ortostática considerando-se as medidas: 1) da fúrcula esternal à papila, para avaliar a necessidade de retirada de pele supra-areolar; 2) da base da mama, para avaliar o volume do implante; 3) das distâncias A e B, para avaliar a forma do implante. Este algoritmo foi aplicado a 59 pacientes submetidas à mamoplastia de aumento. RESULTADOS: Utilizamos implantes redondos em 27 pacientes; nove tinham distância a = b, e 18 B > A. Empregamos implantes anatômicos em 32 pacientes. Os volumes dos implantes redondos variaram entre 195 cc e 425 cc, enquanto os implantes anatômicos ficaram entre 185 cc e 315 cc. Com relação às medidas pós-operatórias das pacientes que utilizaram implantes redondos, 26 (96,3%) mantiveram a proporção desejada com B > A ou A = B. Entre as pacientes com implantes anatômicos, as medidas de 25 delas (78,1%) mostraram alteração das proporções, de A > B para A = B ou B > A. CONCLUSÕES: Quando a distância A é igual ou menor que a distância B, recomendamos implantes redondos. Quando B < A, recomendamos implantes anatômicos.

INTRODUCTION: Several surgeons have their own formulas or protocols to select the volume and shape of breast implants. To determine the shape, we measured the distances between the upper edge of the breast and the papilla (A), and between the papilla and the inframammary fold (B). Based on these measurements, we propose an algorithm to select round or anatomical implants. METHODS: Preoperative assessment was performed with the patients in the orthostatic position. The following distances were considered: 1) from the sternal notch to the papilla, to assess the need for supra-areolar skin excision; 2) breast base, to assess the volume of the implant; 3) distances A and B, to evaluate the shape of the implant. This algorithm was applied to 59 patients undergoing augmentation mammoplasty. RESULTS: We used round implants in 27 patients; nine had a distance A = B, and 18 had B > A. We utilized anatomical implants in 32 patients. The volume of round implants ranged from 195 to 425 cc, whereas that of anatomical implants ranged from 185 and 315 cc. Regarding postoperative measurements of the patients who used round implants, 26 (96.3%) maintained the desired ratio with B > A or A = B. Among the patients with anatomical implants, 25 (78.1 %) showed proportional changes from A > B to A = B or B > A. CONCLUSIONS: When the distance A is equal to or smaller than the distance B, we recommend round implants. When B < A, we recommend anatomical implants.

Image analysis software versus direct anthropometry for breast measurements

PURPOSE: To compare breast measurements performed using the software packages ImageTool(r), AutoCAD(r) and Adobe Photoshop(r) with direct anthropometric measurements. METHODS: Points were marked on the breasts and arms of 40 volunteer women aged between 18 and 60 years. When connecting the points, seven linear segments and one angular measurement on each half of the body, and one medial segment common to both body halves were defined. The volunteers were photographed in a standardized manner. Photogrammetric measurements were performed by three independent observers using the three software packages and compared to direct anthropometric measurements made with calipers and a protractor. RESULTS: Measurements obtained with AutoCAD(r) were the most reproducible and those made with ImageTool(r) were the most similar to direct anthropometry, while measurements with Adobe Photoshop(r) showed the largest differences. Except for angular measurements, significant differences were found between measurements of line segments made using the three software packages and those obtained by direct anthropometry. CONCLUSION: AutoCAD(r) provided the highest precision and intermediate accuracy; ImageTool(r) had the highest accuracy and lowest precision; and Adobe Photoshop(r) showed intermediate precision and the worst accuracy among the three software packages. .

Relevancia de la citología por impronta de las biopsias core en patología mamaria en un hospital público / Importance of imprint cytology of breast core biopsies in a public hospital

Introducción: En la mayoría de los hospitales públicos la demora entre la primera consulta y la cirugía es prolongada. Comenzamos a utilizar la citología por impronta con el objetivo de probar la eficacia y determinar si puede reducir los tiempos para el inicio del tratamiento. Objetivos: Conocer la sensibilidad y la especificidad, conocer la calidad del material obtenido y comparar los tiempos entre los métodos de impronta e histología. Materiales y métodos: Se realizó biopsia core a 99 pacientes con nódulos mamarios no palpables. Al comparar los resultados de la pieza operatoria con los resultados histológicos de la biopsia core, revelan una sensibilidad para la biopsia core del 96,15% y una especificidad del 95,23%. Al comparar los resultados de la pieza operatoria con los resultados de la impronta, se observó una sensibilidad para la impronta citológica de 98,70% y una especificidad del 95,40%. Las muestras por impronta fueron de buena calidad. La demora en la obtención del informe anatomopatológico de la biopsia core fue de 35,53 días, mientras que la demora en el informe de la impronta fue de 2,20 días. Conclusión: La citología por impronta es un método rápido y confiable, que reduce el tiempo de espera del diagnóstico, mejora la sensibilidad y especificidad de la citología por aguja fina.

Sewing Needle in Breast Parenchyma.

A 38 year old woman presented with pain in her left breast for last 8 days. She had a history of fall in road 8 days back. She was investigated with X-ray, ECG but no abnormality found. She was treated symptomatically, but got no relief. When we examined the patient, a stiff cord like structure was found deep in the lower outer quadrant of the left breast parenchyma. In the same old X-ray, a long thin pointed foreign body was seen in parallel and superimposed on an underline rib. The breast was explored under local anesthesia; a swing needle was found and removed. Foreign body like sewing needle in breast tissue is an extremely uncommon clinical condition; proper clinical examination and correlation with investigation can clinch the diagnosis early.

Densidade mamográfica em mulheres menopausadas assintomáticas: correlação com dados clínicos e exames ultrassonográficos / Mammographic density in asymptomatic menopausal women: correlation with clinical and sonographic findings

OBJETIVO: Avaliar a densidade mamográfica de mulheres menopausadas, assintomáticas, correlacionando com dados clínicos e ultrassonográficos. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, as mamografias e os dados clínicos e ultrassonográficos de 238 pacientes assintomáticas, no período entre fevereiro de 2002 e junho de 2006. As variáveis analisadas foram: padrões de densidade mamográfica, achados ultrassonográficos, idade, paridade, índice de massa corporal e uso de terapia de reposição hormonal. RESULTADOS: Idade, paridade e índice de massa corporal apresentaram relação inversa com os padrões de densidade mamográfica, enquanto o uso de terapia de reposição hormonal apresentou relação direta. Foram realizados exames ultrassonográficos complementares em 103 (43,2%) pacientes, sendo constatadas alterações em 34 (33%) delas. Os nódulos ultrassonográficos foram mais frequentes nas mulheres com padrões mamários 3 e 4 e sem expressão mamográfica. CONCLUSÃO: Concluímos que os padrões mamográficos de densidade foram influenciados pela idade, índice de massa corporal, paridade e tempo de uso de terapia de reposição hormonal. Apesar de não termos encontrado alterações malignas nos casos estudados, evidenciamos alterações ultrassonográficas benignas nas mulheres com padrões mamários de alta densidade e que apresentaram mamografias sem alterações, demonstrando a importância da ultrassonografia complementar para a detecção de lesões mamárias nessas pacientes.

OBJECTIVE: To evaluate mammographic breast density in asymptomatic menopausal women in correlation with clinical and sonographic findings. MATERIALS AND METHODS: Mammograms and clinical and sonographic findings of 238 asymptomatic patients were retrospectively reviewed in the period from February/2022 to June/2006. The following variables were analyzed: mammographic density patterns, sonographic findings, patients' age, parity, body mass index and use of hormone replacement therapy. RESULTS: Age, parity and body mass index showed a negative correlation with breast density pattern, while use of hormone replacement therapy showed a positive correlation. Supplementary breast ultrasonography was performed in 103 (43.2%) patients. Alterations which could not be visualized at mammography were found in 34 (33%) of them, most frequently in women with breast density patterns 3 and 4. CONCLUSION: The authors concluded that breast density patterns were influenced by age, parity, body mass index and time of hormone replacement therapy. Despite not having found any malignant abnormality in the studied cases, the authors have observed a predominance of benign sonographic abnormalities in women with high breast density patterns and without mammographic abnormalities, proving the relevance of supplementary ultrasonography to identify breast lesions in such patients.

Influência das características mamárias na cintilografia miocárdica pelo método Monte Carlo / Influence of breast characteristics in myocardial scintigraphy through the Monte Carlo method / Influência das características mamárias na cintilografia miocárdica pelo método Monte Carlo

FUNDAMENTO: Pela redução da especificidade associada à perda de informação, a influência da atenuação das mamas é de fundamental importância em estudos de perfusão do miocárdio. Entretanto, apesar de vários estudos terem sido realizados ao longo dos últimos anos, pouco se tem evoluído para determinar com acurácia a influência das características das mamas sobre a qualidade da cintilografia miocárdica, evitando exposições adicionais de radiação às pacientes. OBJETIVO: O objetivo deste estudo é quantificar a atenuação de fótons pelas mamas, em estudos de perfusão do miocárdio com 99mTc, de acordo com diferentes tamanhos e composições. MÉTODOS: Cada mama foi assumida como sendo um cubo composto de tecido adiposo e fibroglandular. Os dados referentes aos fótons de 99mTc foram analisados em um modelo de Monte Carlo. Variamos a espessura e a composição das mamas e analisamos as interferências na atenuação. Foi empregado o software EGS 4 para as simulações. RESULTADOS: Fixando a espessura de uma mama, a variação da sua composição acarreta um acréscimo máximo de 2,3 por cento no número de fótons atenuados. Em contrapartida, mantendo-se uma composição do tecido mamário fixa, a diferença na atenuação de fótons foi de 45,0 por cento, sendo em média de 6,0 por cento para cada acréscimo de centímetro na espessura da mama. CONCLUSÃO: A simulação por Monte Carlo demonstrou que a influência das espessuras das mamas na atenuação de fótons em cintilografias do miocárdio com 99mTc é muito maior do que a influência das suas composições.

BACKGROUND: By reducing the specificity associated with loss of information, the influence of attenuation of the breasts is very important in myocardial perfusion studies. However, although several studies have been conducted over the past years, little has been developed to determine accurately the influence of the characteristics of the breasts on the quality of myocardial scintigraphy, avoiding additional exposure to radiation. OBJECTIVE: The purpose of this study is to quantify the attenuation of photons by the breasts, in myocardial perfusion studies with 99mTc according to different sizes and compositions. METHODS: Each breast was assumed to be a cube composed of fibroglandular and adipose tissue. The data related to 99mTc photons were analyzed in a Monte Carlo model. We varied the thickness and composition of breasts and analyzed the interference in attenuation. The EGS 4 software was used in the simulations. RESULTS: Setting the thickness of a breast, the variation of its composition causes a maximum increase of 2.3 percent in the number of photons attenuated. By contrast, maintaining a fixed composition of breast tissue, the difference in photon attenuation was 45.0 percent, averaging 6.0 percent for each additional centimeter in the breast thickness. CONCLUSION: Monte Carlo simulation showed that the influence of the thickness of the breasts in the attenuation of photons in myocardial scintigraphy with 99mTc is much greater than the influence of their compositions.

FUNDAMENTO: Por la reducción de la especificidad asociada a la pérdida de información, la influencia de la atenuación de las mamas es de fundamental importancia en estudios de perfusión del miocardio. Entre tanto, a pesar de que varios estudios han sido realizados a lo largo de los últimos años, poco se ha evolucionado para determinar con precisión la influencia de las características de las mamas sobre la calidad de la cámara gamma miocárdica, evitando exposiciones adicionales de radiación a las pacientes. OBJETIVO: El objetivo de este estudio es cuantificar la atenuación de fotones por las mamas, en estudios de perfusión del miocardio con 99mTc, de acuerdo con diferentes tamaños y composiciones. MÉTODOS: Cada mama fue asumida como siendo un cubo compuesto de tejido adiposo y fibroglandular. Los datos referentes a los fotones de99mTc fueron analizados en un modelo de Monte Carlo. Variamos el espesor y la composición de las mamas y analizamos las interferencias en la atenuación. Fue empleado el software EGS 4 para las simulaciones. RESULTADOS: Fijando el espesor de una mama, la variación de su composición acarrea un aumento máximo de 2,3 por ciento en el número de fotones atenuados. En contrapartida, manteniéndose una composición del tejido mamario fija, la diferencia en la atenuación de fotones fue de 45,0 por ciento, siendo en media de 6,0 por ciento para cada aumento de centímetro en el espesor de la mama. CONCLUSIÓN: La simulación por Monte Carlo demostró que la influencia de los espesores de las mamas en la atenuación de fotones en cámara gamma del miocardio con 99mTc es mucho mayor que la influencia de sus composiciones.

Estudios percutáneos de mama: biopsia con aguja gruesa / Percutaneous studies of the breast: core needle biopsy

Técnica desarrollada con el objetivo de obtener una biopsia histológica de los nódulos de mama, que consta de una aguja biselada encamisada y un dispositivo disparador. Se detallan algunas indicaciones para su utilización, materiales necesarios, y entrenamiento.