Feasibility study of immediate breast reconstruction with fusion fascia combined with implants / 中华肿瘤杂志

Objective: To investigate the oncologic and surgical safety of the fused fascia method for immediate breast reconstruction with implants. Methods: The clinical data of 343 patients with immediate breast reconstruction with implants in Tianjin Medical University Cancer Hospital from 2014-2017 were retrospectively analyzed to compare the 5-year local recurrence-free survival, 5-year disease-free survival and 5-year overall survival of patients with breast reconstruction by fusion fascia and other methods, and to analyze the complication incidences of implant removal between different implant groups. Results: Of the 343 patients with breast reconstruction, 95 were in the fused fascia group (fascia group) and 248 were in the non-fascia group (25 in the bovine pericardial patch group and 223 in the muscle flap group). At a median follow-up of 49 months, the differences in 5-year local recurrence-free survival (90.1% and 94.9%, respectively), 5-year disease-free survival (89.2% and 87.6%, respectively), and 5-year overall survival (95.2% and 95.1%, respectively) between patients in the fascial and non-fascial groups were not statistically significant (P>0.05). The complication incidence of implant removal was 24.0% (6/25) in the patch group and 2.1% (2/95) and 2.2% (5/223) in the fascia and muscle flap groups, respectively. Conclusion: Immediate breast reconstruction with fused fascial combined with implant is safe and feasible, less invasive than muscle flaps, more economical and with fewer complications than patches.

Cáncer de mama en hombres: revisión de casos en el Hospital Regional de Talca / Breast cancer in men: review of cases at "Hospital Regional de Talca"

Breast cancer in men is a rare pathology. The most common clinical presentation is a palpable and painless retroareolar nodule. In men, it is a rare pathology, there are few studies on the matter, where breast cancer trials frequently exclude men. Objective: to present the incidence of breast cancer in men from the "Regional Hospital of Talca" Method: Retrospective and descriptive study of cases of breast cancer in men who have been treated and followed up in the Breast Pathology Unit of the Regional Hospital of Talca from January 1, 2011 to December 31, 2021.Results: There were 9 cases of breast cancer in men. Average age at diagnosis was 63 years, all patients were 50 years of age or older. One hundred percent of patients consulted for a self-palpable breast nodule. Average size on physical examination was 30 mm. The most frequent histology was invasive ductal carcinoma (56%), followed by invasive tubular carcinoma (22%) and ductal carcinoma in situ (11%). Immunohistochemistry was 100% positive for estrogen and progesterone receptor. Surgery in 56% of cases was total mastectomy with axillary dissection, and in 33% it was total mastectomy alone. 4 patients underwent adjuvant treatment with chemotherapy, and just one required a combination of chemotherapy and radiotherapy. During follow-up, only 2 patients died. Conclusion. Breast cancer in men is not very prevalent and the management is extrapolated from large studies in women, we believe that it is essential to have studies in male patients, to really have clarity on the behavior and evolution of the disease.

Reconstrucción de herida compleja de tórax posterior a resección agresiva por cáncer de mama avanzado / Complex chest wound reconstruction following aggressive resection for advanced breast cancer

Los grandes defectos torácicos requieren generalmente procedimientos complejos para su reparación; en la mayoría de los casos es necesaria la combinación de tejidos autólogos y materiales protésicos, por lo que constituye un desafío para el cirujano plástico. En nuestra experiencia se presenta una herida compleja de la pared torácica secundaria a exéresis tumoral. En general se dispone de varias opciones reconstructivas para cubrir los defectos resultantes de las amplias escisiones y poder aportar colgajos vascularizados, amplios y voluminosos. A pesar de no disponer en nuestro caso con los tejidos regionales más comúnmente usados, hemos podido dar cobertura a todo el defecto y se ha garantizado una adecuada estabilidad de la pared torácica. Se tuvo como objetivo mostrar la forma en que se realizó la reconstrucción inmediata con la combinación de colgajo de rotación y material protésico. En este artículo se revisa el hemicolgajo dermograso abdominal, la técnica de elevación y sus ventajas e inconvenientes. Se trata de una técnica de gran seguridad, versátil, con pocas secuelas en la zona donante, de tiempo quirúrgico relativamente corto.

Large thoracic defects require complex procedures for repair, in most cases it requires the combination of autologous tissues and prosthetic materials. A complex wound secondary to tumor exeresis was presented in our service. Among the multiple reconstructive options, a rotation and advancement abdominal dermofat hemicolgajo was chosen. Resulting in a technique of great safety, versatile, with little sequel in the donor area, and short surgical time

Incision selection for nipple-sparing mastectomy with implant-based breast reconstruction / 中华外科杂志

Objective: To examine the outcome of different incision selection for nipple-sparing mastectomy (NSM) with implant-based breast reconstruction (IBBR). Methods: Ninety-Two cases accepted NSM and IBBR from totally 1 002 cases of breast cancer admitted to Beijing Tongren Hospital Affiliated to Capital Medical University from June 2013 to December 2020 were analyzed retrospectively. All the patients were female, aging (42.0±7.5) years (range: 27 to 64 years). There were 12 patients at stage 0, 47 patients at stage Ⅰ, 17 patients at stage Ⅱ, and 16 patients at stage Ⅲ. The patients were divided in three groups by the incision: peri-areolar group (n=23), inframammary group (n=33) and lateral group (n=36). The age, tumor size, lymph node status, hormone receptor, operation method and postoperative complications were followed-up of three groups and compared by one-way ANOVA, χ2 test or Fisher's exact test and expansion to comparied. Results: There was no significant difference in operation time ((180.7±54.0) minutes vs. (176.9±48.1) minutes vs. (194.6±37.5) minutes, F=1.401, P=0.252), postoperative drainage volume ((497.5±226.0) ml vs. (495.4±182.5) ml vs. (519.8±172.0) ml, F=0.167, P=0.846) and drainage time ((8.8±3.8) days vs. (8.0±2.5) days vs. (8.3±2.9) days, F=0.542, P=0.583) among the peri-areolar, inframammary, and lateral groups. The cumulative postoperative complications were relatively higher in the peri-areola group (26.1%(6/23) vs. 0 vs.8.3%(3/36), χ²=9.675, P=0.004). All female patients were followed up for (49.0±25.6) months(range: 12 to 112 months). Breast cancer related death rate was 2.2% (2/92), local recurrence was 1.1% (1/92), regional recurrence was 4.3% (4/92), distant metastasis was 6.5% (6/92), and the disease-free survival rate was 88.0% (81/92). Conclusion: The surgical effects of the peri-areolar, inframammary and lateral incisions for NSM and IBBR are approximate, the total complication rate of the peri-areolar incision is slightly higher.

Application of acellular bovine pericardium patch in implant based immediate breast reconstruction / 中华外科杂志

Objective: To examine the clinical effect of acellular bovine pericardium patch in implant based immediate breast reconstruction. Methods: The clinicopathological information of 141 breast cancer patients, who admitted to Department of Breast Reconstruction and Oncoplastic Surgery, Tianjin Medical University Cancer Hospital, underwent immediate mammoplasty with implants combined with acellular bovine pericardium patches were analyzed from June 2016 to October 2019. All patients were female, with the age of (38.8±8.5) years (range: 13 to 60 years). The body mass index was (21.9±2.5) kg/m2 (range: 16.0 to 32.3 kg/m2). There were 39 cases of duct carcinoma in situ, 46 cases of stage Ⅰ, 40 cases of stage Ⅱ and 16 cases of stage Ⅲ. All patients received nipple-areola-sparing mastectomy or skin-sparing mastectomy with sentinel lymph node biopsy or axillary lymph node dissection, and prosthesis implantation with sub-pectoralis combined with breast patch. The correlation of clinicopathological characters and complications was assessed by t test, χ2 test, Fisher's exact probability method and Logistic regression. Pre-and post-operative aesthetic, quality of life scores were recorded. Results: The operation time (M(IQR)) was 3.6(1.5) hours (range: 3.0 to 6.5 hours). The early postoperative complication rate was 22.0% (31/141), prosthesis removal was the main postoperative complication, accounting for 64.5% (20/31) of the total complications, of which 15 cases occurred in the first 30 patients. The follow-up time was 28(8) months (range: 20 to 53 months), The most frequent long-term complications were capsular contracture and implant displacement, with the incidence of 11.2% (14/125) and 10.4% (13/125), respectively. Multivariate analysis showed that prosthesis volume ≥300 ml (OR=8.173, 95%CI: 1.302 to 51.315, P=0.021) and peri-areolar incision (OR=7.809, 95%CI: 2.162 to 28.211, P<0.01) were independent relative factors for the occurrence of short-term postoperative local complications. After 2 years of operation, the score of breast appearance satisfaction was 71.7±15.5, postoperative effect satisfaction was 90.4±9.5, psychological satisfaction was 90.7±17.1, sexual satisfaction was 70.1±25.1. The immediate postoperative satisfaction rate at discharge was 95.4% (134/141), and 17.6% (22/125) of patients had the intention to received revision surgery. Conclusions: Prosthesis volume ≥300 ml and peri-areolar incision were independent realtive factors for short-term local complications after bovine pericardium patch combined with prosthesis implantation in the immediate breast reconstruction. After completing the learning curve, the postoperative complications of the procedure could be decreased.

Surgical management of nipple areola complex in central breast cancer / 中华肿瘤杂志

Objective: To explore the surgical strategy of nipple areola complex (NAC) management in central breast cancer. Methods: A retrospective analysis was conducted on 164 cases of central breast cancer who underwent surgery treatment from December 2017 to December 2020 in the Breast Center of Beijing Tongren Hospital, Capital Medical University. Prior to the surgery, the tumor-nipple distance (TND) and the maximum diameter of the tumor were measured by magnetic resonance imaging (MRI). The presence of nipple invagination, nipple discharge, and nipple ulceration (including nipple Paget's disease) were recorded accordingly. NAC was preserved in patients with TND≥0.5 cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative intraoperative frozen pathological margin. All patients with signs of NAC involvement, TND<0.5 cm or positive NAC basal resection margin confirmed by intraoperative frozen pathology underwent NAC removal. χ(2) test or Fisher exact test was used to analyze the influencing factors. Results: Of the 164 cases of central breast cancer, 73 cases underwent breast-conserving surgery, 43 cases underwent nipple-areola complex sparing mastectomy (NSM), 34 cases underwent total mastectomy, and the remaining 14 cases underwent skin sparing mastectomy (SSM). Among the 58 cases of NAC resection (including 34 cases of total mastectomy, 14 cases of SSM, and 10 cases of breast-conserving surgery), 25 cases were confirmed tumor involving NAC (total mastectomy in 12 cases, SSM in 9 cases, and breast-conserving surgery in 4 cases). The related factors of NAC involvement included TND (P=0.040) and nipple invagination (P=0.031). There were no correlations between tumor size (P=0.519), lymph node metastasis (P=0.847), bloody nipple discharge (P=0.742) and NAC involvement. During the follow-up period of 12 to 48 months, there was 1 case of local recurrence and 3 cases of distant metastasis. Conclusions: For central breast cancer, data suggest that patients with TND≥0.5cm, no signs of NAC invasion (nipple invagination, nipple ulceration) and negative NAC margin in intraoperative frozen pathology should be treated with NAC preservation surgery, whereas for those with TND<0.5 cm or accompanied by signs of NAC invasion, NAC should be removed. In addition, nipple reconstruction can be selected to further improve the postoperative appearance of patients with central breast cancer.

Factors influencing decisions on contralateral symmetrisation procedure among patients with breast cancer

INTRODUCTION@#Oncoplastic breast-conserving surgery (OBCS) can cause breast asymmetry. Although contralateral breast surgery to achieve symmetry was offered to these patients, the uptake of symmetrisation was variable. We aimed to determine the factors that deter patients with breast cancer undergoing OBCS from opting for symmetrisation.@*METHODS@#All patients with breast cancer who underwent OBCS of displacement type with no symmetrisation were prospectively surveyed to explore the social, economic, psychological and physical reasons against symmetrisation.@*RESULTS@#A total of 28 patients participated in a survey administered at a mean 21.6 (range 2-47) months after OBCS. A combination of factors, such as worry and desire to treat breast cancer first (67.9%), not being overly concerned about breast cosmesis (57.1%) and fear of pain from additional operation (28.6%), deterred patients from immediate symmetrisation. Worry and desire to treat breast cancer first was the most important single factor for 50% of the patients. Reasons for no delayed symmetrisation included not being overly concerned about breast cosmesis (70.4%), fear of breast cancer recurrence (48.1%) and being happy with current breast cosmesis (33.3%), with the former two reasons equally cited as the single most important deterrent by 30% of patients each.@*CONCLUSION@#A combination of factors may deter patients from symmetrisation. The most significant factors deterring OBCS among patients were worry and desire to treat breast cancer first for immediate symmetrisation, and not being overly concerned about breast cosmesis and fear of breast cancer recurrence for delayed symmetrisation. Reassuring these patients may increase their uptake of symmetrisation, thereby improving patient cosmesis and satisfaction.

La mastectomía bilateral con reconstrucción inmediata en pacientes con cáncer de mama ¿retrasa el inicio de terapias adyuvantes? / Bilateral mastectomy with immediate reconstruction as a treatment for breast cancer: is it the cause of delays in adjuvant therapies?

Resumen Introducción El tratamiento estándar del cáncer de mama es la cirugía conservadora, aunque actualmente existe un incremento de cirugías más radicales, incluyendo reconstrucción. Estas técnicas, aparentemente más complejas, pueden suponer mayor índice de complicaciones y, por ende, mayor intervalo de tiempo entre la cirugía y el inicio de terapias adyuvantes, lo que puede condicionar peores resultados de los tratamientos, traducido en el índice de recidivas locales y/o sistémicas o incluso de las tasas de supervivencia. Objetivo Revisar si la mastectomía bilateral con reconstrucción inmediata (MBRI) supone un retraso en el inicio del tratamiento adyuvante (TA). Materiales y Método Análisis retrospectivo de pacientes con MBRI como tratamiento de cáncer. Variables principales: tiempo transcurrido entre la cirugía y el inicio de la TA, definiendo retraso como más de 90 días. Otras variables: datos del paciente, tipo de intervención, complicaciones. Se analizan datos por tipo de intervención y si presentaban cirugía conservadora previa. Resultados 296 pacientes con MBRI, 171 (57,7%) por cáncer de novo y 125 (42,3%) por neoplasia recidivada o un segundo primario (ipsi o contralateral). La tasa general de complicaciones fue de 21% y no difirió entre los grupos con y sin radioterapia previa (p 0,05). La técnica quirúrgica asociada a una tasa mayor de complicaciones fue el patrón corto de Wise. No hubo diferencias en el resto. No existió un retraso significativo mayor de 90 días en los grupos con o sin radioterapia, ni según la técnica quirúrgica. Conclusiones La MBRI no ocasiona retrasos significativos en el inicio de TA.

Background Breast conserving surgery is already the standard treatment of breast cancer although mastectomy and radical techniques including reconstruction are currently increasing. These techniques, apparently more complex, can develop more complications and delay adjuvant therapies initiation, conditioning worst results of treatments, with higher rates of local and/or systemic recurrences or even survival rates. Aim Review whether bilateral mastectomy with immediate reconstruction (MBRI) conditionate a delay in the initiation of adjuvant therapy (TA). Materials and Method A retrospective analysis of patients with MBRI as a cancer treatment. Main variable: Time to TA, was defined as the number of days between surgery and the first dose of chemotherapy or radiotherapy. Other variables: patient data, type of intervention and complications. We analyzed the data by type of intervention and if they had been previously treated from another breast tumor. Results In all, 296 patients with MBRI were included, 171 with a Cancer de novo and 125 already treated that now have a relapsed neoplasia or a second primary (IPSI or contralateral). Overall complication rate was 21%. Complication rate did not differ between groups either or neither previous radiotherapy. The surgical technique associated with a higher rate of complications was the short Wise pattern, with no differences in the others. There was no delay greater than 90 days in the groups with radiotherapy or without, or according to the surgical technique. Conclusions MBRI does not cause significant delays in the beginning of adjuvant therapies.

Cáncer de mama ectópica axilar: caso clínico / Ectopic axillary breast cancer: case report

Resumen Introducción El tejido mamario ectópico es consecuencia de la involución incompleta de la cresta mamaria. Su localización más frecuente es axilar siendo más común en el sexo femenino. Nuestro objetivo fue presentar el caso de una patología infrecuente en su localización. Materiales y Método Se presenta el caso de una paciente de 39 años, con diagnóstico de cáncer de mama ectópica en la región axilar izquierda. Resultados Presentamos el estudio y la resolución quirúrgica de una paciente con cáncer de mama ectópica. Discusión La presencia de tejido mamario ectópico ocurre en el 2%-6% de la población general. Este tejido sufre cambios fisiopatológicos similares a los de la mama normal, entre los cuales se encuentra la malignización. El carcinoma primario de este tejido es infrecuente y su manifestación más común es el tumor palpable. Conclusiones La incidencia de carcinoma en tejido ectópico es de 0,3% de todos los cánceres de mama. El tratamiento debe seguir las mismas recomendaciones que el cáncer de mama normotópico, con igual estadio TNM.

Introduction Ectopic mammary tissue is consecuence of the incomplete involution of the mammary crest. The most frequent location is the axillary region and more common in women. Our gol was present the case of an infrequent pathology in its location. Materials and Method A case of a 39-year-old patient with a diagnosis of ectopic breast cancer in the left axillary region. Results We present the study and surgical resolution of a patient with ectopic breast cancer. Discussion Ectopic breast tissue occurs in 2-6% of the general population. This tissue undergoes pathophysiological changes similar to those of the normal breast, among which malignancy is found. The primary carcinoma of this tissue is infrequent and its most common manifestation is the palpable tumor. Conclussion The incidence of carcinoma in ectopic tissue is approximately 0.3% of all breast cancers. Treatment should follow the same recommendations as those for breast tumors with the same TNM stage.

Mastectomía de reducción de riesgo: Experiencia del Centro Mamario del Hospital Universitario Austral / Risk reducing-mastectomy: Experience of the Hospital Universitario Austral Breast Center

Antecedentes: dada la mayor disponibilidad de estudios genéticos, en los últimos años se incrementaron significativamente las mastectomías de reducción de riesgo (MRR). Objetivo: analizar la experiencia institucional en MRR. Material y métodos: se tuvieron en cuenta las pacientes sanas sometidas a MRR bilateral simultánea y también las pacientes con antecedentes de cáncer de mama que luego fueron sometidas a MRR contralateral. No fueron tenidas en cuenta las mastectomías realizadas como tratamiento actual de un cáncer, pero sí la mastectomía contralateral. Resultados: se realizaron 70 MRR en 49 pacientes que cumplían con los criterios de inclusión para el análisis. La edad promedio fue de 44 años (rango 34-64). En 60 casos se conservó el complejo areola-pezón. En 50 casos, la reconstrucción mamaria fue con implante protésico directo. En 57 pacientes la incisión fue radiada en cuadrante superoexterno. En 57 casos no presentaron complicaciones y, de las restantessolo en 1 (1,4%) se perdió el implante. En un solo caso se detectó un carcinoma de mama oculto, y, en la evolución, una paciente desarrolló un carcinoma pequeño en la mama operada. Conclusión: la MRR es una alternativa válida y segura en mujeres con alto riesgo de cáncer de mama, pues logra disminuir en forma significativa la probabilidad de padecer la enfermedad, con buenos resultados estéticos y alto nivel de satisfacción.

Background: The number of risk-reducing mastectomies (RRM) has increased over the past years as genetic testing has become more readily available. Objective: The aim of this study was to analyze the experience of our institution with RRM. Material and methods: The analysis included healthy patients undergoing simultaneous bilateral RRM and those with a history of breast cancer who underwent contralateral RRM. Patients with mastectomies performed as treatment of breast cancer were not considered, but those with contralateral mastectomies were included. Results: Seventy RRM were performed in 49 patients who fulfilled the inclusion criteria for the analysis. Mean age was 44 years (range: 34-64). The nipple-areola complex was preserved in 60 cases. In 50 cases, a prosthesis was implanted for breast reconstruction during the same procedure. The breast was approach through a radial incision in the upper outer quadrant in 57 patients. Fifty-seven patients did not present complications, and in the rest of the cases the implant failed in only one (1.4%) case. An occult breast cancer was detected in only one patient. During follow-up, one patient developed a small carcinoma in the operated breast. Conclusion: RRM is a valid and safe option for women at high risk for breast cancer, since it significantly reduces the probability of developing the disease, with good aesthetic results and a high level of patient satisfaction.

Reconstrucción mamaria inmediata con expansores tisulares / Immediate breast reconstruction with tissue expanders

RESUMEN Introducción: La reconstrucción mamaria postmastectomía es la forma habitual en nuestro país. En el Instituto de Oncología se realizan en la actualidad con sistematicidad de manera inmediata para disminuir el impacto psicológico de la mastectomía. Objetivo: Evaluar el comportamiento de la reconstrucción mamaria inmediata con el uso de expansores tisulares. Métodos: Se realizó un estudio observacional, descriptivo, retrospectivo y longitudinal, en pacientes ingresadas en el Instituto Nacional de Oncología y Radiología con criterios de reconstrucción mamaria inmediata con expansores tisulares, en el periodo comprendido entre octubre de 2015 a diciembre de 2018. El universo estuvo conformado por 51 paciente siendo la muestra 43. Resultados: Predominó la reconstrucción en mujeres entre 40 y 49 de color de la piel blanca. La mayoría con hábitos tóxicos de fumadoras. Se realizó como técnica quirúrgica la reconstrucción inmediata con expansión tisular, fue el más utilizado el anatómico. Las principales complicaciones estuvieron relacionadas con la radioterapia y hábitos tóxicos. Conclusiones: Todas las mujeres se reconstruyeron con expansor tisular, de forma inmediata, con bajo índice de complicaciones(AU)

ABSTRACT Introduction: Postmastectomy breast reconstruction is the usual way in our country. At the Oncology Institute they are currently performed systematically immediately to lessen the psychological impact of mastectomy. Objective: To evaluate the behavior of immediate breast reconstruction with the use of tissue expanders. Methods: An observational, descriptive, retrospective and longitudinal study was carried out in patients admitted to the National Institute of Oncology and Radiology with criteria for immediate breast reconstruction with tissue expanders, in the period from October 2015 to December 2018. The universe it was made up of 51 patients, sample 43. Results: Reconstruction predominated in women between 40 and 49 of white skin color. Most with toxic smoking habits. Immediate reconstruction with tissue expansion was performed as a surgical technique, anatomical was the most used. The main complications were related to radiation therapy and toxic habits. Conclusions: All the women were reconstructed with a tissue expander, immediately, with a low rate of complications(AU)

Whole sequencing of the mitochondrial genome of breast cancer tissue in Mexican-mestizo postmenopausal women with different body mass index

Abstract Background Mitochondrial and oxidative stress has been related to obesity and breast cancer being this cancer more frequent and more aggressive in postmenopausal women with obesity. Objective The objective of this study was to investigate whether Mexican-Mestizo postmenopausal women with breast cancer and obesity present different somatic mutations in the mitochondrial DNA (mtDNA) when compared to women with normal body mass index (BMI). Subjects and Methods We included six Mexican-Mestizo postmenopausal women bearing breast cancer and who underwent mastectomy or breast-conserving surgery. BMI was determined in each case. Patients’ genomic DNA was isolated from blood leukocytes and tumor tissue samples. Whole mtDNA sequence was determined by MitoChip v2.0 mitochondrial resequencing array, and data were analyzed using the GeneChip Sequence Analysis Software. Tumor mtDNA sequence was compared with matched leukocyte mtDNA sequence. Results Three women had a normal BMI and three presented obesity. Overall, we found 64 genetic variants: 53.1% were somatic mutations and 46.9% were polymorphisms; 44.1% were in the non-coding region and 55.9% were in genes that encode for mitochondrial proteins. Among the somatic mutations, 67.7% were in patients with normal BMI and 32.3% in patients with obesity. Conclusions We did not find a higher frequency of mitochondrial somatic mutations in postmenopausal women with breast cancer and obesity compared to those with normal BMI. However, results could be due to the small number of women studied.

Mammary adenectomy followed by immediate reconstruction for treatment of patients with early-infiltrating breast carcinoma: a cohort study

ABSTRACT BACKGROUND: Use of mammary adenectomy for breast carcinoma treatment remains controversial. OBJECTIVE: This study aimed to verify the oncological safety of mammary adenectomy and immediate breast reconstruction for treating selected patients with infiltrating breast carcinoma and to evaluate patients' satisfaction with the reconstructed breasts. DESIGN AND SETTING: Cohort study conducted among patients treated at Hospital Sírio-Libanês, São Paulo, Brazil. METHODS: This study was based on 152 selected patients (161 operated breasts) with infiltrating breast carcinoma who underwent mammary adenectomy and immediate breast reconstruction. In all patients, the diameter of the largest focus of the tumor was less than 3.0 cm, the imaging tumor-nipple distance was greater than 2.0 cm and the pathological assessment showed clear margins. The cumulative incidence of local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. After at least one year of follow-up, 64 patients were asked about their satisfaction with the reconstructed breast(s). RESULTS: At a mean follow-up time of 43.5 months, seven cases of LR (4.4%), four distant metastases (2.6%) and five deaths (3.3%) were recorded. The five-year actuarial LR-free survival, RFS and OS were 97.6%, 98.3% and 98.3%, respectively. No cases of nipple-areolar complex recurrence were reported. Forty-one patients (64%) indicated a high level of satisfaction with the reconstructed breasts. CONCLUSIONS: Mammary adenectomy is a safe and efficacious procedure for selected patients with early-infiltrating breast carcinoma and results in a high rate of patient satisfaction with the reconstructed breasts.

Mastectomia: reconstruccion inmediata con colocacion de expansores mamarios / Mastectomy: immediate reconstruction with placement of mammary expansors

La reconstrucción mamaria es parte fundamental del tratamiento de la mujer mastectomizada por cáncer de mama. Tras comprobarse que la reconstrucción no influye negativamente sobre la enfermedad neoplásica, sino que es trascendental para la rehabilitación física y psicológica de la paciente, su desarrollo se ha visto favorecido. Este trabajo monográfco muestra el trababjo en equipo dentro del quirófano y el rol del isntrumentador(AU)

Mammary reconstruction is a fundamental part of the treatment of women mastectomized for breast cancer. After confrming that the reconstruction does not negatively influence the neoplastic disease, but is transcendental for the physical and psychological rehabilitation of the patient, its development has been favored. Tis monographic work shows teamwork within the operating room and the role of the isntrumentor(AU)

A reconstrução mamária é parte fundamental do tratamento de mulheres mastectomizadas para câncer de mama. Após confrmar que a reconstrução não influencia negativamente a doença neoplásica, mas é transcendental para a reabilitação física e psicológica do paciente, seu desenvolvimento tem sido favorecido. Este trabalho monográfco mostra o trabalho em equipe dentro da sala de cirurgia e o papel do instrumental(AU)

Reconstruções mamárias: estudo retrospectivo de 16 anos / Breast reconstructions: a 16-year retrospective study

Introdução: Câncer de mama é o segundo tipo mais comum de câncer entre mulheres no Brasil. Estimam-se 59.700 casos novos de câncer de mama para o biênio 2018-2019. Reconstrução mamária é um procedimento seguro e vários procedimentos cirúrgicos são descritos para sua realização: técnicas conservadoras, retalhos de vizinhança, materiais aloplásticos, retalhos miocutâneos pediculados e microcirúrgicos. O objetivo deste estudo foi analisar os casos de reconstrução mamária pósmastectomia por câncer de mama, realizados em um período de 16 anos. Métodos: Foi realizada revisão de prontuários de pacientes submetidas à reconstrução mamária pós-mastectomia por câncer de mama, no período de janeiro de 2002 a dezembro de 2017. Resultados: No período analisado, 586 pacientes foram submetidas à reconstrução mamária. Em 160 pacientes a reconstrução mamária foi realizada com retalho miocutâneo do músculo retoabdominal (TRAM), 107 com técnicas conservadoras, 156 com retalho miocutâneo do músculo grande dorsal (RGD), 113 com próteses e 50 secundárias. Previamente a outubro de 2007, a porcentagem de pacientes submetidas a cirurgias bilaterais, somando-se TRAM e RGD, era de 30%, e a partir desse período a porcentagem passou para 83,3%. Houve algum tipo de complicação ou intercorrência em 203 (34,64%) pacientes operadas, totalizando de 335 complicações. Grande maioria apresentou intercorrências tratadas ambulatorialmente sem necessidade de reabordagem cirúrgica. Conclusão: Houve aumento da incidência de cirurgias bilaterais, fato atribuído ao aumento das mastectomias profiláticas na mama contralateral e aumento do número de reconstruções utilizando RGD em comparação com o TRAM, bem como o aumento significativo das reconstruções com implante de silicone.

Introduction: Breast cancer is the second most common type of cancer among women in Brazil. An estimated 59,700 new cases of breast cancer were reported in the 2018­2019 biennium. Breast reconstruction is a safe procedure, and various surgical procedures have been described, including conservative techniques and use of neighborhood flaps, alloplastic materials, and pedicled and microsurgical myocutaneous flaps. The objective of this study was to analyze cases of breast reconstruction after mastectomy for breast cancer performed over a period of 16 years. Methods: We reviewed the medical records of patients who underwent breast reconstruction after mastectomy for breast cancer between January 2002 and December 2017. Results: Within the study period, 586 patients underwent breast reconstruction. Breast reconstruction was performed with a transverse rectus abdominis myocutaneous muscle (TRAM) flap in 160 patients, with conservative techniques in 107 patients, with a latissimus dorsi myocutaneous flap (LDMF) in 156 patients, with prostheses in 113 patients, and secondarily in 50 patients. Before October 2007, the proportion of patients who underwent bilateral surgeries with a TRAM flap and LDMF was 30%, and since then, the percentage has increased to 83.3%. One or more types of complications occurred in 203 patients (34.64%) who underwent surgery, with a total of 335 complications . Most outpatient complications did not require surgical reassessment. Conclusion: The incidence of bilateral surgery increased, which is attributed to the increase in the number of prophylactic mastectomies in the contralateral breast and in the number of reconstructions using a LDMF compared with that using a TRAM flap. A significant increase in the number of reconstructions with silicone implants was also observed.

Qualidade de vida e resultado estético após mastectomia e reconstrução mamária / Quality of life and aesthetic results after mastectomy and mammary reconstruction

Introdução: Em decorrência do aumento na incidência de câncer de mama, a procura pela reconstrução mamária vem crescendo, juntamente com a preocupação em relação à satisfação e à qualidade de vida das pacientes. Mastectomia pode ser vivenciada de modo traumático, sendo considerada mutilação, afetando autoestima e estabilidade emocional. O questionário BREAST-Q® foi validado internacionalmente e formulado para avaliação pré e pós-operatória da qualidade de vida relacionada à reconstrução mamária. O objetivo do estudo é avaliar a qualidade de vida e satisfação com o resultado estético das pacientes submetidas à reconstrução mamária com implantes, comparando o período anterior com o período posterior à reconstrução mamária. Métodos: Realizado estudo observacional longitudinal retrospectivo por meio da revisão de prontuários de pacientes submetidas à reconstrução mamária com uso de implantes de silicone ou de expansor de tecido no período de janeiro de 2014 a dezembro de 2016, associado a estudo transversal por meio da aplicação do questionário Breast-Q® e avaliação do resultado estético após análise fotográfica pré e pós-operatória. Resultados: Foram selecionadas 74 pacientes que foram submetidas à reconstrução mamária com implantes (79,7% com prótese de silicone e 20,3% com expansor); 95,94% das reconstruções foram imediatas e não houve predomínio quanto à lateralidade. Obtivemos significância estatística tanto no domínio satisfação com a mama quanto no domínio bem-estar físico. A maioria dos casos foram considerados satisfatórios pelo avaliador externo. Conclusão: A qualidade de vida das pacientes no período posterior à reconstrução mamária com implantes mamários é superior em relação ao período anterior ao procedimento cirúrgico.

Introduction: Due to the increased incidence of breast cancer, the demand for breast reconstruction has been increasing, along with concerns regarding the satisfaction and quality of life of the patients. Mastectomy can be a traumatic experience, especially when it is perceived as a mutilation, which can impact self-esteem and emotional stability. The BREAST-Q® questionnaire was internationally validated and formulated for the pre- and postoperative assessment of quality of life related to breast reconstruction. This study aimed to evaluate quality of life and aesthetic result satisfaction in patients who underwent breast reconstruction with implants by comparing the period after breast reconstruction with the period before. Method: A retrospective longitudinal observational study was carried out by reviewing the charts of patients who underwent breast reconstruction using silicone or tissue expander implants from January 2014 to December 2016, in association with a cross-sectional study of the Breast-Q® questionnaire and an evaluation of aesthetic results based on photographic analysis before and after surgery. Results: We selected 74 patients who underwent breast reconstruction with implants (79.7% with silicone prostheses and 20.3% with expanders); 95.94% of the reconstructions were immediate, and no particular laterality predominated. We obtained statistical significance in the domains of both breast satisfaction and physical well-being. Most cases were considered satisfactory by the external evaluator. Conclusion: The patients' quality of life in the period after breast reconstruction with breast implants was superior to that in the period prior to the procedure.

Complicações da reconstrução imediata da mama após mastectomia total com uso de prótese cônica e não cônica / Complications of immediate breast reconstruction after total mastectomy using conical and non-conical prostheses

Introdução: No biênio 2016-2017 foram estimados pelo Instituto Nacional do Câncer (INCA) aproximadamente 2.160 casos novos de câncer para o estado do Ceará e 57.960 casos novos para cada 100.000 mulheres no Brasil. A reconstrução mamária com implante de material aloplástico apresenta complicações cirúrgicas precoces e tardias que são direta ou indiretamente relacionadas à técnica cirúrgica utilizada para a realização da mastectomia e a implantação do material sintético. O presente estudo tem por objetivo analisar as complicações encontradas em um grupo de pacientes submetidas à reconstrução mamária imediata com uso de prótese cônica e não cônica. Métodos: Corresponde a um estudo de coorte transversal, retrospectivo, observacional com análise de prontuário de pacientes que foram submetidos à mastectomia total poupadora de pele com reconstrução imediata da mama com o uso de prótese cônica e não cônica, no período de janeiro de 2016 a janeiro de 2018, realizada pelo Serviço de Cirurgia Plástica e Microcirurgia Reconstrutiva do HUWC da Universidade Federal do Ceará. Resultados: As complicações ocorreram em 13 (54,1%). A prótese que apresentou o maior número de complicações foi a de formato cônico, com complicações em 7 (63,6%) pacientes, enquanto somente 6 (46,1%) pacientes com prótese de formato não cônica apresentaram complicações. Conclusão: O nosso estudo mostrou maior frequência de complicações com o uso de próteses cônicas em relação à não cônica devido principalmente à formação de uma área de sofrimento na ponta da prótese cônica que resultou em extrusão das mesmas.

Introduction: In the biennium 2016-2017, approximately 2,160 new cancer cases were identified by the Brazilian National Cancer Institute (Instituto Nacional do Câncer; INCA) for the state of Ceará and 57,960 new cases for every 100,000 women in Brazil. Breast reconstruction with alloplastic implants presents early and late surgical complications directly or indirectly related to the surgical technique used to perform mastectomy and implantation of the synthetic material. This study aimed to analyze the complications found in a group of patients submitted for immediate breast reconstruction using conical and non-conical prostheses. Methods: This is a cross-sectional, retrospective, observational cohort study that analyzed the medical records of patients who underwent skin-sparing total mastectomy with immediate breast reconstruction using conical and non-conical prostheses, performed by the Plastic Surgery and Reconstructive Microsurgery Service at the HUWC of the Federal University of Ceará from January 2016 to 2018. Results: A total of 13 (54.1%) patients presented with complications. The conical prostheses showed the highest number of complications, i.e., 7 (63.6%) patients, whereas only 6 (46.1%) patients with non-conical prostheses had complications. Conclusion: Our study showed a higher frequency of complications with the use of conical prostheses when compared to non-conical prostheses, mainly due to the formation of a sore area at the tip of the conical prosthesis that resulted in extrusion.

Análise da participação de hospital universitário em um mutirão nacional de reconstrução mamária / Analysis of the participation of a university hospital in a national program for breast reconstruction

Introdução: Mesmo com os avanços das cirurgias conservadoras, a mastectomia ainda é uma cirurgia bastante realizada. Todavia, muitas pacientes não conseguem submeter-se à reconstrução imediata, passando a integrar uma crescente fila à espera da cirurgia reparadora. Com o intuito de diminuir tal demanda, foram criados os programas de mutirão cirúrgicos. O objetivo deste trabalho é analisar os resultados referentes ao 2º Mutirão Nacional de Reconstrução Mamária (MNRC), realizado no Serviço de Cirurgia Plástica do Hospital Universitário Walter Cantídio (SCPMR-HUWC). Método: Estudo de coorte prospectiva, no qual foram avaliadas as 16 pacientes submetidas à reconstrução mamária no 2º MNRM no SCPMR-HUWC. As pacientes foram acompanhadas pelo período de 6 meses e os dados obtidos foram tabelados e analisados. Resultados: 16 pacientes, todas mulheres, foram submetidas à reconstrução mamária pós-mastectomia. A idade variou entre 39 e 72 anos, com média de 49 anos. Dentre as complicações precoces, foram observados seroma em região dorsal (13%), necrose parcial da pele da mastectomia (6%), deiscência parcial da ferida operatória (13%) necrose do retalho de grande dorsal (6%). Nenhuma das pacientes apresentou complicações tardias. O período de internação variou de 1 a 5 dias. Todas as pacientes que estavam na fila do SCPMR-HUWC de cirurgia foram operadas. Conclusões: Foi verificado alto grau de satisfação por parte das pacientes operadas e bons resultados obtidos, com poucas repercussões funcionais. Assim, concluímos que os mutirões de reconstrução mamária pós-mastectomia são uma alternativa viável em termos de saúde pública.

Introduction: Despite advances in conservative surgeries, mastectomy is still a commonly performed procedure. However, many patients are unable to undergo immediate reconstruction. Such patients are integrated into a growing queue for restorative surgery. With the intention of reducing this demand, surgical Task Force programs were created. The objective of this study was to analyze the results of the second National Task Force of Breast Reconstruction (NTFBR), performed at the Plastic Surgery Service of Walter Cantídio University Hospital (SCPMRHUWC). Method: A prospective cohort study was conducted, in which 16 patients underwent breast reconstruction at SCPMRHUWC. The patients were followed up for 6 months, and their data were tabulated and analyzed. Results: All 16 female patients underwent breast reconstruction after mastectomy. The patients' ages ranged from 39 to 72 years. Among the early complications, seroma in the dorsal region (13%), partial necrosis of the mastectomy skin (6%), partial dehiscence of the operative wound (13%), and necrosis of the large dorsal flap (6%) were observed. None of the patients had late complications. The period of hospitalization ranged from 1 to 5 days. All patients who were in the SCPMR-HUWC queue for surgery were operated on. Conclusions: In this study, a high degree of satisfaction was verified by the operated patients, and good results were obtained with few functional complications. Thus, we conclude that the Task Force of breast reconstruction after mastectomy is a viable alternative in terms of public health.

Effect of breast cancer treatment on the stomatognathic system

Abstract Breast cancer is the most common cancer affecting women in the world and provides functional changes in the human body. Evaluate women submitted to unilateral mastectomy, through electromyographic activity (mandibular rest, right and left laterality, protrusion, maximum voluntary contraction with and without Parafilm, habitual and non-habitual mastication) and thickness (rest and maximum voluntary contraction) of the right temporal muscle (RT), left temporal (LT), right masseter (RM) and left masseter (LM), also the molar bite force (right and left) and compare the data with healthy women. Material and Methods: 32 women were divided into two groups: unilateral mastectomy group (MG), average ± standard deviation 56.50±14.50 years (n=16) and without the disease group (CG), average ± standard deviation 56.56±14.15 years (n=16). The normalized electromyographic data, muscle thickness and maximal molar bite force were tabulated and submitted to statistical analysis (SPSS 21.0; student t test, p≤0.05). Significant statistical differences between MG and CG were found in right laterality, for RM (p=0.02); left laterality, for LT (p=0.01); chewing with peanuts, for RM (p=0.04); chewing with raisins, for LM (p=0.04) and right molar bite force (p=0.03). There was no statistically significant difference between MG and CG for muscle thickness. The results of this study suggest that women undergoing unilateral mastectomy may present functional changes, with emphasis on muscular hyperactivity, lower masticatory efficiency and lower maxillary bite force.

Resumo Câncer de mama é a neoplasia mais comum que mais acomete mulheres no mundo e proporciona alterações funcionais no corpo humano. Objetivo: avaliar mulheres submetidas à mastectomia unilateral, por meio da atividade eletromiográfica (repouso mandibular, lateralidade direita e esquerda, protrusão, contração voluntária máxima com e sem parafilme, mastigação habitual e não habitual) e espessura (repouso e contração voluntária máxima) do músculo temporal direito (TD), temporal esquerdo (TE), masseter direito (MD) e masseter esquerdo (ME), além da força de mordida molar (direita e esquerda) e comparar os dados com mulheres saudáveis. 32 mulheres foram distribuídas em dois grupos: grupo mastectomia unilateral (GM), média ± desvio padrão 56,50 ± 14,50 anos (n=16) e grupo sem a doença (GC), média ± desvio padrão 56,56 ± 14,15 anos (n=16). Os dados eletromiográficos normalizados, espessura muscular e força de mordida molar máxima foram tabulados e submetidos à análise estatística (SPSS 21.0; teste t de student, p≤0,05). Foram encontradas diferenças estatísticas significantes entre GM e GC na lateralidade direita, para o MD (p=0,02); lateralidade esquerda, para o TE (p=0,01); mastigação com amendoim, para o MD (p=0,04); mastigação com uva-passa, para o ME (p=0,04) e força de mordida molar direita (p=0,03). Não houve diferença estatística significante entre GM e GC para espessura muscular. Os resultados deste estudo sugerem que mulheres submetidas à mastectomia unilateral podem apresentar alterações funcionais do sistema estomatognático, com destaque para hiperatividade muscular, menor eficiência mastigatória e menor força de mordida molar máxima.

Carcinoma de mama masculina / Male breast carcinoma

El cáncer mamario en hombres es una enfermedad poco frecuente. Sólo representa 1 por ciento de todos los cánceres de mama y es responsable del 0,1 por ciento de las muertes por cáncer en el hombre. Su incidencia se ha incrementado en los últimos 25 años. Generalmente la forma de presentación de la enfermedad es una masa indolora, retroareolar, con retracción del pezón o no. La enfermedad en estadios avanzados (etapa III-IV) ocurre en más del 40 por ciento de los pacientes. La variedad histopatológica más frecuente es el carcinoma ductal infiltrante y el tratamiento de elección es la mastectomía radical modificada con vaciamiento axilar. El objetivo de este trabajo es la presentación de dos casos diagnosticados y tratados en el Hospital Salvador Allende, además de actualizar el tema(AU)

Breast cancer in men is a rare disease. It accounts only for 1 percent of all breast cancers and is responsible for 0.1 percent of cancer deaths in men. Its incidence has increased in the last 25 years. Generally speaking, the form of presentation of the disease is a painless mass, which is retroareolar, with retraction of the nipple or without it. The disease in advanced stages (stages III-IV) occurs in more than 40 percent of patients. The most frequent histopathological variety is the infiltrating ductal carcinoma and the treatment of choice is modified radical mastectomy with axillary dissection. The objective of this work is the presentation of two cases diagnosed and treated at Salvador Allende Hospital, in addition to updating the topic(AU)