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1.
Rev. argent. mastología ; 40(145): 13-35, mar. 2021. ilus, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1283641

ABSTRACT

El linfoma anaplásico de células grandes asociado a implantes mamarios LACG-AI o BIA-ALCL, abreviatura en inglés de "Breast Implant Associated-Anaplastic Large Cell Lymphoma", es una nueva entidad reconocida por la OMS desde el 2016, de rara incidencia y que aún plantea muchos interrogantes. Desde su primera mención en 1997 (J. Keech - B. Creech) su incidencia ha ido en aumento. En julio de 2020, 953 casos en el mundo según el Registro de la Sociedad Americana de Cirujanos Plásticos (PROFILE), y las publicaciones se multiplican exponensialmente año a año demostrando el interés que suscita. Se ha descripto una fuerte asociación con las superficies texturizadas de los implantes mamarios y con el tipo de material (mayor textura "grado 4" y cubierta de poliuretano mayor riesgo) llegando a describirse tasas tan altas omo 1/2830 en Australia/Nueva Zelanda. Su presentación clínica en casi el 75% es bajo la forma de un seroma tardío y el tiempo de exposición promedio ronda entre los 7 a 11 años. El diagnóstico histo-patológico integra el examen morfológico con la caracterización molecular, visualizándose grandes célular anaplásicas CD30 (+), ALK (-). El tratamiento quirúrgico, capsulectomía bilateral en estadios tempranos es el gold standard. Su pronóstico es excelente con exérsis completas. Objetivo: actualizar la información sobre esta novel enfermedad y comentar un caso propio que presenta todas las características descriptas en la literatura, siendo el 14° registrado en Argentina


The anaplastic large cell lymphoma associated with breast implants, LACCG-AI o BIA-ALCL abbreviation in English, is an entity recognized by the WHO since 2016 of rare incidence and that still raises many questions. Since its firts mention in 1997 (J. Keech - B. Creech) its incidence has been increasing, In july 2020, 953 cases in the world according to the Registry of the America Society of Plastic Surgeons (PROFILE), and the publications multiply exponentially year after year, demonstrating the interest it arouses, A strong association has been described with the textured surfaces of breast implants and with the type of material (greater texture "grade 4" and higher risk polyurethane cover), reaching rates as high as 1/2830 in Australia / New Zealand. Its clinical presentation in almost 75% is in the form of a late seroma and the average exposure time is between 7 to 11 years. The pathological anatomical diagnosis integrates the morphological examination with the molecular characterization, visualizing large anaplastic CD30 (+), ALK (-) cells. Surgical treatment, bilateral capsulectomy in early stages, is the gold standard. Her prognosis is excellent with complete exeresis. Objetive: to update the information on this novel disease and comment on an own case that presents all the characteristics described in the literature, the 14th being registered in Argentina


Subject(s)
Lymphoma, Large-Cell, Anaplastic , Polyurethanes , Breast Implants
2.
Rev. méd. Minas Gerais ; 31: 31408, 2021.
Article in Portuguese | LILACS | ID: biblio-1291383

ABSTRACT

A mastite é uma patologia relativamente frequente na mulher que amamenta. Surge maioritariamente nas primeiras seis semanas após o parto (prevalência entre 75-95% antes do bebé completar os três meses de vida), podendo, contudo, ocorrer ao longo de todo o período da amamentação. Apresenta-se clinicamente com mastalgia, eritema e edema mamário, linfonodomegalia axilar, febre, calafrios, mal-estar e prostração. Entretanto, o quadro clínico completo pode não estar presente em todos os casos. A técnica incorreta de amamentação provoca as microlesões mamáriasque são fatores associados à mastite, inicialmente, e esta quando não recebe tratamento adequado pode evoluirpara os abscessos mamários, que são caracterizados clinicamente por nodulação palpável ou não, flutuante, parcialmente circunscrita, geralmente no quadrante superior lateral da mama afetada. O microrganismo mais envolvido é o Staphylococcus aureus. O diagnóstico diferencial envolve principalmente outras causas não infecciosas de mastite, por exemplo a granulomatosa com reação a corpo estranho (piercing, implantes de silicone) e também malignidade. A ultrassonografia é um método bastante útil na investigação inicial daqueles quadros com suspeita de desenvolvimento de tal complicação e possibilita de maneira segura o tratamento minimamente invasivo e a obtenção de amostra para analise laboratorial. Isto permite a escolha de antibioticoterapia direcionada para os microorganismos causadores.


Mastitis is a relatively common condition in breastfeeding women. It appears mostly in the first six weeks after delivery (prevalence between 75-95% before the baby is three months old), however, it can occur throughout the entire period of breastfeeding. It may present clinically with mastalgia, erythema and breast edema, axillary lymph node enlargement, fever, chills, malaise and prostration. However, the complete clinical picture may not be present in all cases. The incorrect breastfeeding technique causes breast microlesions which are factors associated with mastitis, initially, and when it does not receive adequate treatment it can evolve for breast abscesses, which are characterized clinically by palpable or not, floating, partially circumscribed nodulation, usually in the upper lateral quadrant of the affected breast. The most involved microorganism is Staphylococcus aureus. The differential diagnosis mainly involves other non-infectious causes of mastitis, for example granulomatous with a foreign body reaction (piercing, silicone implants) and also malignancy. Ultrasonography is a very useful method in the initial investigation of those conditions suspected of developing such a complication, and it safely allows minimally invasive treatment and obtaining a sample for laboratory analysis. This allows the choice of antibiotic therapy directed at the causative microorganisms.


Subject(s)
Humans , Female , Adult , Silicones , Breast Implants , Mastitis , Staphylococcus aureus , Wounds and Injuries , Breast Feeding , Diagnostic Imaging , Ultrasonography, Mammary , Infections , Inflammation , Anti-Bacterial Agents/therapeutic use
4.
Rev. cir. (Impr.) ; 71(6): 566-570, dic. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1058320

ABSTRACT

Resumen Introducción: El tumor Phyllodes mamario es una entidad muy poco frecuente, con tendencia a la recidiva local y una tasa de malignización de 5-10%. La base de su tratamiento es la resección quirúrgica. Material y Métodos: Mujer de 32 años diagnosticada de un tumor Phyllodes maligno en mama derecha sometida en otro centro a cirugía conservadora con colocación de expansor y a dos tumorectomías posteriores por recidiva local. Fue referida a nuestro Hospital al presentar una nueva recidiva de gran tamaño (9,2 cm) para valoración de intervención quirúrgica. Resultados: Se realizó exéresis del tumor (remanente de tejido mamario y músculo pectoral mayor) y retirada del expansor con reconstrucción mamaria con colgajo de dorsal ancho en el mismo tiempo quirúrgico. En el momento actual la paciente se encuentra pendiente de iniciar tratamiento radioterápico. Conclusiones: El tumor Phyllodes maligno es una entidad poco frecuente y cuyo manejo terapéutico se basa en la resección quirúrgica con márgenes. De forma adyuvante se puede administrar quimiorradioterapia. Es de gran importancia realizar un manejo multidisciplinar e individualizado de cada caso para ofrecer el mejor pronóstico.


Introduction: Phyllodes tumor is a rare entity, with a high tendency to local recurrence and a malignancy rate of 5-10%. The basis of its treatment is the surgical resection. Materials and Method: We report a 32-year-old woman who was diagnosed of a malignant Phyllodes tumor who had previously underwent conservative breast surgery and expander placement in another center. Two subsequent lumpectomies due to local recurrences were necessary. She was referred to our Hospital for she presented a new large-sized recurrence (9.2 cm) at the retroarelor area for assessment of new surgical treatment. Results: Surgical resection of the tumor (remnant of mammary tissue and pectoralis major muscle) and removal of the expander with immediate breast reconstruction with latissimus dorsi flap was performed. At the present time, the patient is pending radiotherapeutic treatment. Conclusions: Malignant Phyllodes tumor is a rare entity whose therapeutic management is based on margin-free surgical excision. Adjuvant chemoradiotherapy might be administered. It is very important to carry out a multidisciplinary and individualized management of each case to offer the best possible forecast.


Subject(s)
Humans , Female , Adult , Breast Neoplasms/complications , Mammaplasty/methods , Phyllodes Tumor/surgery , Neoplasm Recurrence, Local , Breast Neoplasms/diagnostic imaging , Mammaplasty/adverse effects , Phyllodes Tumor/diagnostic imaging , Breast Implants
5.
Rev. bras. cir. plást ; 34(4): 531-538, oct.-dec. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1047921

ABSTRACT

O linfoma anaplásico de grandes células associado ao implante de mama (Breast Implant Associated Anaplastic Large Cell Lymphoma - BIA-ALCL) é uma doença maligna recentemente descoberta, rara e possivelmente associada aos implantes mamários texturizados. Essa revisão da literatura teve como objetivo trazer novas atualizações acerca da epidemiologia, fisiopatologia e fatores de risco para desenvolvimento do BIAALCL. Foi realizado o levantamento de dados do período de dezembro de 2018 a fevereiro de 2019, através das bases de dados PUBMED, LILACS e Scielo sendo selecionados 10 artigos publicados entre 2016 e 2018. Foi encontrada uma incidência variando entre 2,8:100.000 a 1:3 milhões de pacientes com implantes mamários. Os dados coletados corroboram para a teoria de que não há uma relação direta de causa e efeito entre os implantes mamários, mormente os texturizados, e o desenvolvimento do BIA-ALCL, podendo esses ser considerados somente como fatores de risco e não agentes causadores. A teoria fisiopatológica mais aceita é a de que os implantes mamários com maior área de superfície levariam a formação de maior biofilme por maior adesão bacteriana gerando inflamação crônica mais proeminente, levando ao gatilho para a transformação maligna das células T. As informações explicitadas nessa revisão devem auxiliar na ampliação de estudos acerca da doença e criação de políticas públicas para a prevenção e diagnóstico precoce de tal enfermidade. Pelos dados encontrados há necessidade de que cirurgiões plásticos realizem acompanhamento mais próximo de seus pacientes, assim como orientem os pacientes antes das cirurgias sobre a existência da doença.


Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) is a newly discovered and rare cancer possibly associated with textured breast implants. This literature review investigates its epidemiology, pathophysiology, and risk factors. PubMed, LILACS, and SciELO databases were searched from December 2018 to February 2019, and 10 articles published between 2016 and 2018 were selected. The incidence of BIA-ALCL ranged from 2.8:100,000 to 1:3 million breast implants. The obtained data corroborate the hypothesis that there is no direct cause and effect relationship between breast implants, especially textured implants, and BIA-ALCL, and these implants can be considered risk factors but not causative factors. The most accepted hypothesis on disease pathophysiology is that breast implants with larger surface areas may promote bacterial adhesion and biofilm formation, leading to severe chronic inflammation, triggering the malignant transformation of T cells. This review provides knowledge on BIA-ALCL and helps develop and implement public policies for disease prevention and timely diagnosis. The data highlight that long-term follow up is necessary and that surgeons should advise patients of the potential risk of developing BIA-ALCL before performing the implant surgery.


Subject(s)
Humans , History, 21st Century , Lymphoma, Non-Hodgkin , Breast Neoplasms , Lymphoma, T-Cell , Review , Lymphoma, Large-Cell, Anaplastic , Breast Implants , Breast Neoplasms/physiopathology , Hodgkin Disease/physiopathology , Lymphoma, T-Cell/physiopathology , Lymphoma, Large-Cell, Anaplastic/surgery , Lymphoma, Large-Cell, Anaplastic/physiopathology , Breast Implants/statistics & numerical data
6.
Rev. argent. mastología ; 38(140): 48-57, dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1116270

ABSTRACT

Objetivo El objetivo del presente trabajo es analizar la evolución de las pacientes sometidas a reconstrucción mamaria inmediata con implantes asistidos con mallas de poliglactina 910. Material y método Se colocaron 135 mallas de poliglactina en 100 pacientes. En 35 pacientes, la reconstrucción mamaria fue bilateral y en 65 casos fue unilateral. En 71 casos (52,6%), se realizó con implante mamario directo y en 64 (47,4%) con expansor tisular transitorio seguido de reemplazo por prótesis definitiva. En 87 casos (64,4%), la herida cutánea no estaba en contacto con la malla, y en 48 (35,6%) la malla estaba en contacto con el tejido celular subcutáneo y la herida quirúrgica. 18 reconstrucciones mamarias fueron realizadas en tejidos previamente irradiados mientras que 7 pacientes fueron irradiadas luego de la mastectomía. Resultados Se registraron 32 complicaciones en 25 pacientes. En 21 pacientes (84%), se requirió corrección quirúrgica. En total, fueron 7 implantes perdidos (5,2%), 5 de los cuales tenían antecedentes de radioterapia previa. Conclusiones Pudimos constatar la buena adaptación de las mallas de poliglactina a la técnica quirúrgica, permitiendo obtener buenos resultados iniciales con una adecuada tasa de complicaciones. Las pacientes con tratamientos radiantes son los más expuestos a complicaciones y pérdidas del implante


Objective To assess the outcomes in patients undergoing implant-based immediate breast reconstruction assisted with polyglactin 910 mesh. Materials and method 135 polyglactin meshes were placed in 100 patients. In 35 patients, breast reconstruction was bilateral and in 65 cases it was unilateral. The reconstruction was performed in 71 cases (52.6%) with a definitive breast implant and in 64 cases (47.4%) with a tissue expander followed later by its replacement for a definitive prosthesis. In 87 cases (64.4%) the wound was not in contact with the mesh, and in 48 (35.6%) the mesh was in contact with the subcutaneous cellular tissue and the surgical wound. 18 breast reconstructions were performed on previously irradiated tissues while 7 patients received postmastectomy radiotherapy. Results There were 32 complications in 25 patients. In 21 cases (84%) there was some surgical procedure required. There were 7 implants lost (5.2%), 5 of which belonged to patients that had previous radiotherapy history. Conclusions We acknowledge the good adaptation of the polyglactin meshes to the surgical technique, allowing to obtain good results with low complications rate. Patients with radiotherapy are the most exposed to complications and implant losses


Subject(s)
Mammaplasty , Breast Implants , Mastectomy
7.
Rev. bras. cir. plást ; 34(3): 324-330, jul.-sep. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1047147

ABSTRACT

Introdução: Ao longo dos últimos anos os benefícios das reconstruções imediatas se tornaram cada vez mais documentados na literatura e, hoje, o predomínio é pelas reconstruções imediatas. Nos últimos anos, o número de reconstruções com expansores e próteses tem aumentado. Métodos: Estudo retrospectivo entre 2013 e 2014. Foram incluídas as pacientes submetidas à mastectomia, seguida de reconstrução de mama, e assim separadas em dois grupos: 1 - submetida a reconstrução direta com prótese e 2 - expansor. Diversos dados foram avaliados. Resultados: Foram realizadas 138 reconstruções assim divididos: 57 com prótese e 81 com expansor-prótese. As complicações pós-operatórias não mostraram diferença entre os grupos. Radioterapia não teve influência nas complicações. Pacientes que fizeram reconstrução com prótese realizaram menos cirurgias (1,78 vs 2,54) e menos retornos pós-operatórios (8 vs 11,75). Conclusão: As reconstruções imediatas com prótese ou expansor apresentam baixas e semelhantes taxas de complicações pós-operatórias. Pacientes submetidas às reconstruções com prótese tiveram menor taxa de retorno e número de cirurgias para finalizar a reconstrução.


Introduction: The benefits of immediate reconstruction have been increasingly documented in the literature over the past few years. Today, with some exceptions, immediate reconstruction is the preferred surgical choice for breast cancer patients. In the recent years, the number of reconstructions using expanders and implants has increased. Methods: This retrospective study conducted between 2013 and 2014 included patients undergoing mastectomy followed by breast reconstruction, who were divided into direct implant reconstruction and expander treatment groups. Several variables were evaluated. Results: A total of 138 reconstructions (57 implants and 81 expander-implant) were performed. There were no intergroup differences in postoperative complications. Radiotherapy did not influence complications. Implant reconstruction patients underwent fewer surgeries (1.78 vs 2.54) and had fewer postoperative returns (8 vs 11.75). Conclusion: Immediate implant and expander-implant reconstruction approaches present low and similar postoperative complication rates. Patients undergoing implant reconstruction had a lower return rate and underwent fewer surgeries than those undergoing expander-implant reconstruction.


Subject(s)
Humans , Female , Middle Aged , History, 21st Century , Postoperative Complications , Breast , Retrospective Studies , Mammaplasty , Breast Implants , Reconstructive Surgical Procedures , Postoperative Complications/surgery , Breast/surgery , Breast/injuries , Mammaplasty/methods , Breast Implants/adverse effects , Reconstructive Surgical Procedures/methods
8.
Rev. bras. cir. plást ; 34(2): 210-217, apr.-jun. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-1015970

ABSTRACT

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.


Subject(s)
Humans , Adult , Middle Aged , Surgical Flaps/surgery , Breast Neoplasms/surgery , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Mastectomy/adverse effects , Mastectomy/methods , Breast Implants
9.
Rev. bras. cir. plást ; 34(1): 120-126, jan.-mar. 2019.
Article in English, Portuguese | LILACS | ID: biblio-994565

ABSTRACT

Introdução: A cirurgia de mama, especialmente as associadas aos implantes de silicone, teve uma crescente popularização, tornando-se a cirurgia plástica mais realizada no mundo. Junto com esta proliferação, observa-se um aumento da preocupação com a segurança dos implantes mamários de silicone, pelas intercorrências relacionadas. Objetivo: Revisar métodos existentes para minimizar as complicações relacionadas com implante mamário de silicone, bem como as tecnologias existentes e tendências tecnológicas para implantes mamários de silicone. Métodos: Foi realizada revisão de artigos científicos relacionados com novas tecnologias e tendências para redução das complicações relacionadas com implantes mamários de silicone, bem como as patentes e fabricantes de implante de silicone mamário. Resultados: Identificamos inicialmente 78 referências, sendo reduzido para 40 para publicação, todos com linhas de pesquisas que buscam melhores resultados e redução das complicações relacionadas com implantes de silicone, seja esta cirurgia com objetivo estético ou reconstrutivo. Conclusão: A busca por um implante mamário que reduza as possíveis e frequentes complicações, principalmente a formação do biofilme, processos infecciosos e resposta imune, é o foco da maioria das pesquisas encontradas. Com o mesmo objetivo, porém surgindo mais recentemente como alternativas, existem as pesquisas para o uso de matriz dérmica acelular e a lipoenxertia, com boas expectativas.


Introduction: Breast surgery with silicone implants is gaining popularity and has become the most performed plastic surgery worldwide. However, there is increasing concern about the safety of silicone breast implants due to associated complications. Objective: To review existing technologies, technological trends, and existing methods to minimize complications related to silicone breast implants. Methods: We conducted a literature review of articles describing new technologies and trends to reduce complications related to silicone breast implants, along with information on patents and manufacturers of silicone breast implants. Results: We initially identified 78 articles, out of which 40 were shortlisted for publication . All articles had a common aim of obtaining better results and reducing complications related to silicone implants, either in aesthetic or reconstructive surgeries. Conclusion: The search for a breast implant that reduces possible and frequent complications, especially biofilm formation, infectious processes, and abnormal immune response, was the focus of most articles studied. Acellular dermal matrix and fat grafting have been reported in the literature as promising alternatives.


Subject(s)
Humans , Female , Middle Aged , Aged , Silicone Elastomers/adverse effects , Silicone Elastomers/standards , Breast Neoplasms/surgery , Mammaplasty/methods , Breast Implants/adverse effects , Breast Implants/standards , Reconstructive Surgical Procedures/methods , Reconstructive Surgical Procedures/trends
10.
Article in English | WPRIM | ID: wpr-785330

ABSTRACT

Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.


Subject(s)
Acellular Dermis , Breast Implants , Breast , Congenital Abnormalities , Female , Humans , Mammaplasty , Mastectomy , Postoperative Complications
11.
Article in English | WPRIM | ID: wpr-762858

ABSTRACT

The Goldilocks technique for breast reconstruction utilizes redundant mastectomy flap tissue to construct a breast mound. This technique is suitable for women who decline, or are poor candidates for, traditional postmastectomy reconstruction. Moreover, this technique can be applied in secondary operations after the failure of initial reconstruction efforts. A 74-year-old patient underwent the Goldilocks procedure after reconstruction failure with an implant and acellular dermal matrix. At her 6-month follow-up, the cosmetic outcome of the procedure was satisfactory, and no complications were noted. Therefore, the Goldilocks procedure is a safe alternative to reconstruct breast mounds following reconstruction failure, especially in obese patients.


Subject(s)
Acellular Dermis , Aged , Breast Implants , Breast , Female , Follow-Up Studies , Humans , Mammaplasty , Mastectomy , Methods , Seroma
12.
Article in English | WPRIM | ID: wpr-762846

ABSTRACT

BACKGROUND: The use of anatomic implants has improved the aesthetic results of breast surgery; however, implant malrotation is an uncommon, but serious complication of these procedures. Nevertheless, little research has explored implant adhesion. In this study, we investigated adhesion between the expander and the capsule. METHODS: Seventy-nine cases of immediate breast reconstruction via two-stage implant-based reconstruction performed between September 2016 and November 2017 were evaluated. Mentor CPX4 expanders were used in 14 breasts, and Natrelle expanders in 65. We analyzed areas of adhesion on the surfaces of the tissue expanders when they were exchanged with permanent implants. We investigated whether adhesions occurred on the cephalic, caudal, anterior, and/or posterior surfaces of the expanders. RESULTS: Total adhesion occurred in 18 cases, non-adhesion in 15 cases, and partial adhesion in 46 cases. Of the non-adhesion cases, 80% (n=12) were with Mentor CPX4 expanders, while 94.4% (n=17) of the total adhesion cases were with Natrelle expanders. Of the partial adhesion cases, 90.7% involved the anterior-cephalic surface. The type of tissue expander showed a statistically significant relationship with the number of attachments in both univariate and multivariate logistic regression analyses (P<0.001) and with total drainage only in the univariate analysis (P=0.015). CONCLUSIONS: We sought to identify the location(s) of adhesion after tissue expander insertion. The texture of the implant was a significant predictor of the success of adhesion, and partial adhesion was common. The anterior-cephalic surface showed the highest adhesion rate. Nevertheless, partial adhesion suffices to prevent unwanted rotation of the expander.


Subject(s)
Breast Implantation , Breast Implants , Breast , Drainage , Female , Humans , Logistic Models , Mammaplasty , Mentors , Tissue Expansion Devices
13.
Article in English | WPRIM | ID: wpr-762837

ABSTRACT

The development of breast implant technology continues to evolve over time, but changes in breast shape after implantation have not been fully elucidated. Thus, we performed computerized finite element analysis in order to better understand the trajectory of changes and stress variation after breast implantation. The finite element analysis of changes in breast shape involved two components: a static analysis of the position where the implant is inserted, and a dynamic analysis of the downward pressure applied in the direction of gravity during physical activity. Through this finite element analysis, in terms of extrinsic changes, it was found that the dimensions of the breast implant and the position of the top-point did not directly correspond to the trajectory of changes in the breast after implantation. In addition, in terms of internal changes, static and dynamic analysis showed that implants with a lower top-point led to an increased amount of stress applied to the lower thorax. The maximum stress values were 1.6 to 2 times larger in the dynamic analysis than in the static analysis. This finding has important implications for plastic surgeons who are concerned with long-term changes or side effects, such as bottoming-out, after anatomic implant placement.


Subject(s)
Breast Implantation , Breast Implants , Breast , Computer Simulation , Female , Finite Element Analysis , Gravitation , Mammaplasty , Motor Activity , Plastics , Surgeons , Thorax
14.
Article in English | WPRIM | ID: wpr-762831

ABSTRACT

BACKGROUND: In implant-based breast reconstruction, acellular dermal matrix (ADM) is essential for supporting the inferolateral pole. Recent studies have compared non-sterilized freeze-dried ADM and sterilized pre-hydrated ADM, but have not assessed whether differences were attributable to factors related to sterile processing or packaging. This study was conducted to compare the clinical outcomes of breast reconstruction using two types of sterile-processed ADMs. METHODS: Through a retrospective chart review, we analyzed 77 consecutive patients (85 breasts) who underwent tissue expander/implant breast reconstruction with either freeze-dried ADM (35 breasts) or pre-hydrated ADM (50 breasts) from March 2016 to February 2018. Demographic variables, postoperative outcomes, and operative parameters were compared between freeze-dried and pre-hydrated ADM. Biopsy specimens were obtained for histologic analysis. RESULTS: We obtained results after adjusting for variables found to be significant in univariate analyses. The total complication rate for freeze-dried and pre-hydrated ADMs was 25.7% and 22.0%, respectively. Skin necrosis was significantly more frequent in the freeze-dried group than in the pre-hydrated group (8.6% vs. 4.0%, P=0.038). All other complications and operative parameters showed no significant differences. In the histologic analysis, collagen density, inflammation, and vascularity were higher in the pre-hydrated ADM group (P=0.042, P=0.006, P=0.005, respectively). CONCLUSIONS: There are limited data comparing the outcomes of tissue expander/implant breast reconstruction using two types of sterile-processed ADMs. In this study, we found that using pre-hydrated ADM resulted in less skin necrosis and better integration into host tissue. Pre-hydrated ADM may therefore be preferable to freeze-dried ADM in terms of convenience and safety.


Subject(s)
Acellular Dermis , Biopsy , Breast Implants , Breast , Collagen , Female , Humans , Inflammation , Mammaplasty , Necrosis , Product Packaging , Retrospective Studies , Skin , Sterilization
15.
Article in English | WPRIM | ID: wpr-762744

ABSTRACT

BACKGROUND: Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. METHODS: From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. RESULTS: The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). CONCLUSIONS: It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.


Subject(s)
Body Mass Index , Breast Implants , Breast , Diabetes Mellitus , Drug Therapy , Female , Humans , Mammaplasty , Mastectomy , Menopause , Operating Rooms , Water
16.
Article in English | WPRIM | ID: wpr-739378

ABSTRACT

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.


Subject(s)
Acellular Dermis , Arm , Breast Implants , Breast , Carcinoma, Ductal , Cicatrix , Contracture , Female , Freedom , Hematoma , Humans , Mammaplasty , Mastectomy , Necrosis , Robotic Surgical Procedures , Sentinel Lymph Node Biopsy , Seroma , Surgeons , Tissue Expansion Devices
17.
Journal of Breast Cancer ; : 109-119, 2019.
Article in English | WPRIM | ID: wpr-738411

ABSTRACT

PURPOSE: The use of immediate breast reconstruction (IBR) has been debated because it may be a causative factor in adjuvant treatment delay and may subsequently increase the probability of recurrence. We investigated whether IBR was related to adjuvant treatment delay and survival outcomes. METHODS: We retrospectively analyzed the duration from operation to adjuvant treatment administration and survival outcomes according to IBR status among patients with breast cancer who underwent mastectomy followed by adjuvant chemotherapy from January 2005 to December 2014. Propensity score matching was performed to balance the clinicopathologic baseline characteristics between patients who did and did not undergo IBR. RESULTS: Of 646 patients, 107 (16.6%) underwent IBR, and the median follow-up was 72 months. The median duration from surgery to adjuvant chemotherapy was significantly longer in patients who underwent IBR than in those who did not (14 vs. 12 days, respectively, p = 0.008). Based on propensity score matching, patients who underwent IBR received adjuvant therapy 3 days later than those who did not (14 vs. 11 days, respectively, p = 0.044). The duration from surgery to post-mastectomy radiation therapy (PMRT) did not significantly differ between the 2 groups. Local recurrence-free survival, regional recurrence-free survival, systemic recurrence-free survival, and overall survival were also not significantly different between the 2 groups (p = 0.427, p = 0.445, p = 0.269, and p = 0.250, respectively). In the case-matched cohort, survival outcomes did not change. CONCLUSION: IBR was associated with a modest increase in the duration from surgery to chemotherapy that was statistically but not clinically significant. Moreover, IBR had no influence on PMRT delay or survival outcomes, suggesting that it is an acceptable option for patients with non-metastatic breast cancer undergoing mastectomy.


Subject(s)
Breast Implants , Breast Neoplasms , Breast , Chemotherapy, Adjuvant , Cohort Studies , Drug Therapy , Female , Follow-Up Studies , Humans , Mammaplasty , Mastectomy , Propensity Score , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies
18.
Rev. bras. cir. plást ; 33(4): 463-468, out.-dez. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-979964

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Middle Aged , Postoperative Complications/surgery , Postoperative Complications/therapy , Prostheses and Implants/adverse effects , Breast/surgery , Breast/injuries , Breast Neoplasms/surgery , Breast Neoplasms/complications , Breast Implants/adverse effects , Reconstructive Surgical Procedures/methods , Mastectomy/methods , Prostheses and Implants
19.
Rev. bras. cir. plást ; 33(4): 453-462, out.-dez. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-979963

ABSTRACT

Introdução: O trabalho descreve 14 anos em reconstrução mamária com o retalho miocutâneo do grande dorsal (RGD) e implantes mamários. O objetivo é delinear experiência com o RGD e implantes mamários, programações das ilhas de pele e detalhes da dissecção, transposição de retalho e colocação do implante sob dupla camada muscular, estratégias para minimizar os danos na área doadora, estratégias de simetrização mamária e reconstrução do complexo areolopapilar, associado a avaliação do questionário Breast-Q. Métodos: Foi realizada revisão de prontuários entre abril de 2003 a junho de 2017. Resultados: No período 76 pacientes foram reconstruídas com o RGD, com idade média de 50,09 anos, sendo 11 bilaterais, 34 mama direita e 31 mama esquerda. 41 imediatas, 22 tardias e 13 de resgate. A média de satisfação foi 72,36% por meio do Breast-Q. Conclusão: Concluímos e comprovamos com o questionário do Breast-Q que a indicação precisa aliada a técnica de reconstrução proposta com plano duplo subpeitoral associada a cobertura do RDG, propicia uma loja mais segura, diminuído o índice de rippling.


Introduction: The paper describes a 14-year experience with breast reconstruction using a latissimus dorsi myocutaneous flap (LDMF) and breast implants. The objective was to delineate the experience with LDMF and breast implants, skin island schedules and dissection details, flap transposition and placement of the implant under a double layer, strategies to minimize damage in the donor area, and strategies of breast symmetry and reconstruction of the nipple-areola complex, in association with evaluation using the Breast-Q questionnaire. Methods: A review of medical records was performed between April 2003 and June 2017. Results: In the period, 76 patients with a mean age of 50.09 years underwent reconstruction with a LDMF, which was bilateral in 11, for the right breast in 34, for the left breast in 31, immediate in 41, late in 22, and for rescue in 13. Conclusion: We conclude and verified with the Breast-Q questionnaire that with a precise indication, the proposed reconstruction technique with a double subpectoral plane and coverage with a LDMF is safer with a lower complication rate.


Subject(s)
Humans , Female , Middle Aged , Surgical Flaps/surgery , Breast/surgery , Mammaplasty/methods , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Surveys and Questionnaires , Patient Satisfaction , Breast Implants , Ethical Review
20.
Rev. bras. cir. plást ; 33(3): 317-323, jul.-set. 2018. ilus
Article in English, Portuguese | LILACS | ID: biblio-965540

ABSTRACT

Introdução: Mastopexia associada à inclusão de implante é uma situação desafiadora para o cirurgião plástico. O objetivo é descrever a colocação de implante submuscular com descolamento anatômico mais pexia firme do tecido glandular usando pontos de fixação do tecido mamário ao muscular e analisar os resultados estéticos das pacientes operadas. Método: Foram realizadas 23 mastopexias com implantes no período entre abril de 2015 e julho de 2017, pelo mesmo cirurgião, sendo as mamas das pacientes marcadas previamente, na posição sentada. Realizou-se incisão no sulco mamário e descolamento até o polo superior da mama no plano subfascial, fixação da glândula ao músculo peitoral maior com 9 a 12 pontos. A seguir, iniciou-se a dissecção do músculo peitoral maior através de sua origem costal e transição com os músculos reto abdominal e serrátil, liberando amplamente na porção inferior. Introduziu-se o implante e completou-se a mastopexia. Os tamanhos dos implantes variaram de 255ml a 355ml. Fotos das mamas de 12 pacientes foram avaliadas por dois cirurgiões plásticos e dois leigos, nos seguintes parâmetros: resultado estético, simetria das aréolas e grau de ptose mamária. As avaliações podiam ser Ruim, Razoável ou Bom. Resultados: A técnica cirúrgica mostrou-se reprodutível, apenas 1 caso de hematoma unilateral, nenhuma infecção, queixas de dor discretas. Apenas um caso foi considerado, por um único avaliador, como Razoável; as demais avaliações consideradas como Bom. Conclusão: O tratamento de ptoses mamárias com colocação de implante submuscular acrescido de pexia da glândula ao músculo peitoral é uma técnica reprodutível e com bons resultados estéticos.


Introduction: Mastopexy associated with implant placement is challenging for plastic surgeons. The objective is to describe the placement of a submuscular implant with anatomical detachment in combination with stable fixation of the breast tissue to the pectoralis muscle and analyze the aesthetic results. Method: Twenty-three mastopexy procedures with implants were performed from April 2015 to July 2017 by the same surgeon, and surgical markings were made in the breasts of the patients in a seated position. An incision was made in the inframammary fold, and the breast tissue was elevated to the upper pole in the subfascial plane and attached to the pectoralis major muscle using 9-12 stitches. Subsequently, the inferior margin of the pectoralis major muscle and the transition from the rectus abdominis muscle to the serratus muscle were dissected to expose the muscle. The implant was introduced and mastopexy was completed. Implant size ranged from 255 mL to 355 mL. Photographs of the breasts of 12 patients were evaluated by two plastic surgeons and two non-medical subjects, who considered the aesthetic results, symmetry of the nipple-areola complex, and degree of breast ptosis. The results were scored as unsatisfactory, satisfactory, or good. Results: The surgical technique was reproducible; there was only one case of unilateral hematoma, no implant infections, and only complaints of mild pain. Only one case was scored as satisfactory by one evaluator, whereas the results of the other cases were considered good. Conclusion: The treatment of breast ptosis with the placement of a submuscular implant in combination with fixation of the breast to the pectoralis major muscle is reproducible and yields good aesthetic results.


Subject(s)
Humans , Female , Adult , Breast/surgery , Tissue Fixation/methods , Mammaplasty/adverse effects , Mammaplasty/methods , Breast Implants/adverse effects , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods , Breast , Tissue Fixation , Mammaplasty , Breast Implants , Reconstructive Surgical Procedures
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