Nursing care regarding the psycho-emotional aspects of women submitted to mastectomy / Assistência de enfermagem frente aos aspectos psicoemocionais de mulheres mastectomizadas

Breast cancer, or breast neoplasm, is one of the most frequent types of cancer, and one of the most prevalent among women. The diagnosis and specific treatments, such as mastectomy surgery, lead women to experience different feelings, with the most predominant negative thoughts. In this way, the objective of this study is to describe the importance of nursing care in the face of the psycho-emotional aspects of women after mastectomy. This is an integrative literature review study, developed in electronic Medline and Lilacs databases. The following terms were used: Breast neoplasm; Nursing; Emotions; Mastectomy. A total of 2,314 articles were found, of which eight were selected. The results and discussions were divided into two thematic axes: The first deals with the emotions of women after mastectomy, whose feelings arising from the diagnosis of the disease start to affect different areas, such as personality, sexuality, family, and social relationships. Furthermore, the second deals with nursing care after mastectomy, which must be conducted integrally, aiming at restoring physical and emotional health. Nursing is the vehicle capable of planning and collaborating with these women, promoting humanized treatment and assistance, oriented and aimed at a better quality of life, and stimulating self-help, self-esteem, and acceptance of their body.

O câncer de mama ou neoplasia da mama, é um dos tipos de cânceres mais frequentes, e um dos mais prevalentes entre as mulheres. O diagnóstico e determinados tratamentos, como a cirurgia de mastectomia, levam as mulheres a vivenciarem diferentes sentimentos, sendo os pensamentos negativos os mais predominantes. Desta maneira, o objetivo deste estudo é descrever a importância da assistência do enfermeiro frente aos aspectos psicoemocionais de mulheres mastectomizadas. Trata-se de um estudo de revisão integrativa da literatura, desenvolvida nas bases eletrônicas de dados Medline e Lilacs. Foram utilizados os seguintes descritores: Neoplasias da mama; Enfermagem; Emoções; Mastectomia. Foram encontrados 2314 artigos, dos quais foram selecionados oito. Os resultados e discussões foram divididos em dois eixos temáticos: O primeiro trata das emoções das mulheres mastectomizadas, cujos sentimentos advindos com o diagnóstico da doença passam a afetar diferentes aspectos psicoemocionais, como personalidade, sexualidade, família e relações sociais. E o segundo trata da assistência de enfermagem após a mastectomia, a qual deve se dar de maneira integral, visando tanto o restabelecimento da saúde física quanto emocional. A enfermagem pode desempenhar um cuidado diferenciado e voltado para as necessidades psicoemocionais das mulheres, promovendo tratamento e assistência humanizados, orientados e voltados a uma melhor qualidade de vida, e com o fim de estimular a autoajuda, a autoestima e a aceitação de seu corpo.

Significados atribuídos por mulheres com câncer de mama ao grupo de apoio / Meanings attributed by women with breast cancer to a support group / Significados atribuidos por las mujeres con cáncer de mama al grupo de apoyo

A sobrevivência ao câncer de mama é um problema de saúde pública que demanda serviços especializados com foco na reabilitação psicossocial. Entre as necessidades identificadas nesse contexto está o incentivo à adoção de estratégias de promoção de autocuidados pelas mulheres. Uma das estratégias adotadas consiste no grupo de apoio psicológico, que auxilia as pacientes a enfrentar a longa jornada do tratamento. Assim, o objetivo deste estudo é compreender os significados produzidos por mulheres com câncer de mama sobre sua participação em um grupo de apoio. Trata-se de um estudo qualitativo, descritivo e exploratório realizado com dez mulheres com câncer de mama usuárias de um serviço de reabilitação para mastectomizadas. Como referencial metodológico foi utilizada a Teoria Fundamentada nos Dados. A coleta de dados foi realizada por meio de entrevista aberta em profundidade e os conteúdos foram transcritos e codificados. A análise indutiva e o método de comparação constante foram aplicados nos processos de codificação aberta, axial e seletiva, que permitiram identificar três categorias nucleares: percepção das atividades realizadas no grupo, identificação de benefícios e barreiras do convívio no grupo e transformações decorrentes da participação. As participantes significaram sua presença no grupo como fonte de acolhimento, apoio, desenvolvimento de recursos pessoais e amizades, contribuindo para promover sua qualidade de sobrevida. Além dos potenciais benefícios, também foram identificadas barreiras que podem dificultar a adesão e continuidade da participação no grupo, o que sugere a necessidade de incorporar no cuidado um olhar para as dimensões subjetivas da saúde da mulher.(AU)

Surviving breast cancer is a public health problem and depends on services focused on psychosocial rehabilitation. Healthcare providers must encourage women to adopt strategies to promote their self-care. The psychological support group is a resource that helps women to face the long journey of treatment. This study aimed to understand the meanings women with breast cancer produced about their participation in a support group. This exploratory cross-sectional study was carried out with 10 women with breast cancer who use a rehabilitation service for mastectomized patients. Grounded Theory was used as a methodological reference. An open in-depth interview was applied for data collection. The contents were transcribed and coded. Inductive analysis and the constant comparison method were applied in the open, axial, and selective coding processes, which enabled the identification of three core categories: perception of the activities carried out in the group, identification of benefits and barriers of living in the group, and transformations resulting from participation. Participants denote their involvement with the group as a source of shelter, support, development of personal resources and friendships that helps promoting quality of life. Besides these potential benefits, participants also evinced barriers that can hinder adherence and continuity of participation in the group, suggesting the importance of incorporating a look at the subjective dimensions of women's health into care.(AU)

Sobrevivir al cáncer de mama es un problema de salud pública que depende de los servicios centrados en la rehabilitación psicosocial. Entre las necesidades identificadas en esta materia se encuentra el uso de estrategias para promover el autocuidado. Uno de los recursos que ayuda a afrontar el largo camino del tratamiento es el grupo de apoyo psicológico. El objetivo de este estudio es conocer los significados que producen las mujeres con cáncer de mama sobre su participación en un grupo de apoyo. Se trata de un estudio cualitativo, descriptivo y exploratorio, realizado con diez mujeres con cáncer de mama usuarias de un servicio de rehabilitación para mastectomizadas. Como referencia metodológica se utilizó la teoría fundamentada en los datos. Se aplicó una entrevista abierta en profundidad para la recogida de datos, cuyos contenidos fueron transcritos y codificados. El análisis inductivo y el método de comparación constante se aplicaron en los procesos de codificación abierta, axial y selectiva, lo que permitió identificar tres categorías centrales: percepción de las actividades realizadas en el grupo, identificación de los beneficios y las barreras de vivir en el grupo y transformaciones resultantes de la participación. Las mujeres denotan su participación en el grupo como una fuente de acogida, apoyo, desarrollo de recursos personales y amistades, que ayuda a promover la calidad de vida. Además de los beneficios potenciales, también se identificaron barreras que pueden dificultar la adherencia y continuidad de la participación en el grupo, lo que sugiere la necesidad de incorporar en la atención una mirada centrada en las dimensiones subjetivas de la salud de las mujeres.(AU)

Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study

Abstract Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Radioterapia previa a la mastectomía para facilitar la reconstrucción mamaria inmediata / Premastectomy Radiation Therapy to Facilitate Immediate Breast Reconstruction

Les explicaré cómo la radiación complica la reconstrucción mamaria, particularmente en pacientes que necesitan una mastectomía. Tradicionalmente solemos administrar la radiación después de nuestra cirugía y, a menudo, en los Estados Unidos, Europa y en otros lugares, cuando sabemos que el paciente va a necesitar radioterapia postmastectomía, no recibirá ninguna reconstrucción. De hecho, en nuestro estudio clínico en el MD Anderson, solo alrededor del 50% de las pacientes recibió su reconstrucción cuando la deseaban, debido a las complicaciones de la radiación. Sabemos que la reconstrucción diferida tiene un gran efecto psicológico inmediato para la paciente que se hace una mastectomía que no está balanceada. Por supuesto que este es un resultado muy lindo, pero hubiera sido muy bueno si hubiéramos podido preservar su simetría y darle una reconstrucción inmediata. Esto lo hizo un colega mío del que verán muchas fotos, Mark Schaverien, que es un cirujano de mama del Reino Unido que vino al MD Anderson para aprender cirugía microvascular, ahora es profesor y participa en todos nuestros estudios clínicos y reconstrucciones

Manejo actual de la irradiación de ganglios linfáticos regionales (RNI) después de la quimioterapia neoadyuvante / Current management of Regional Lymph Node Irradiation (RNI) after Neoadjuvant Chemotherapy

Buenos días, muchísimas gracias a la organización por invitarme a este maravilloso Congreso. Como escuchamos antes sobre la cirugía posquimioterapia neoadyuvante para manejar la axila, yo no voy a hablar del manejo de los ganglios después de la quimioterapia. Más bien en esta charla quiero hablar de estos temas: definición de RNI, indicaciones en adyuvancia, evidencia actual de RNI post neoadyuvancia, y estudios clínicos. ¿En qué consiste la irradiación de los ganglios regionales? Para que estemos hablando de lo mismo; cuando hablo de irradiación total de ganglios regionales quiere decir: la axila "no disecada" (donde se ha hecho linfadenectomía axilar o biopsia de ganglio centinela), los supraclaviculares que están en continuidad y los de la mamaria interna, que son los primeros tres espacios intercostales. Me refiero a radiacién de ganglios regionales como algo que puede darse después de la mastectomía o post tumorectomía

Formas de enfrentamento do câncer de mama: discurso de mulheres mastectomizadas / Ways of coping with breast cancer: discourse of mastectomized women

Introdução: Na neoplasia de mama ocorrem inúmeras transformações na vida da pessoa acometida e de todas as pessoas próximas, sentimentos como medo, angústia e tristeza. Diante disso, a identificação dos métodos usados para enfrentar a neoplasia de mama faz-se crucial, visto que proporciona melhor vivência desse momento por parte da mulher e de todos os envolvidos. Objetivo: Compreender as formas de enfrentamento do câncer de mama por meio do discurso de participantes de um grupo de apoio. Metodologia: Pesquisa descritiva com abordagem qualitativa realizada com 10 mulheres que participam de um grupo geral de apoio, localizado em um município da Paraíba, Brasil. Para a coleta de dados, utilizou-se entrevista semiestruturada, e como processo metodológico para a análise dos dados, o Discurso do Sujeito Coletivo. Resultados: Foi possível a compreensão de três ideias centrais em relação às formas de enfrentamento do câncer de mama: ''Ancoragem na fé e espiritualidade''; ''Suporte familiar''; e ''Grupo de apoio''. Conclusão: O estudo atingiu seu objetivo de identificar as principais formas de enfrentamento do câncer de mama por mulheres mastectomizadas, podendo elucidar a importância da fé e espiritualidade, o suporte familiar e a participação em grupos de apoio por meio do discurso das participantes.

Introducción: Con el cáncer de mama se producen numerosos cambios en la vida de la persona afectada y de las personas cercanas, en los que se manifiestan sentimientos como el miedo, la angustia y la tristeza. Ante eso, la identificación de los métodos utilizados para enfrentar el cáncer de mama es crucial, ya que permite una mejor vivencia de ese momento para la mujer y los involucrados. Objetivo: Comprender las formas de afrontamiento del cáncer de mama, a través del discurso de mujeres mastectomizadas en un grupo de apoyo. Metodología: Investigación descriptiva con enfoque cualitativo realizada con 10 mujeres que participan en un grupo de apoyo, ubicado en un municipio de Paraíba, Brasil. Para la recolección de datos, se utilizaron entrevistas semiestructuradas. Además, como proceso metodológico de análisis de datos, se aplicó el Discurso Colectivo del Sujeto. Resultados: Fue posible comprender tres ideas centrales sobre las formas de enfrentamiento del cáncer de mama: ''Anclaje en la fe y la espiritualidad''; ''Apoyo familiar''y ''Grupo de apoyo''. Conclusión: El estudio alcanzó su objetivo de identificar las principales formas de enfrentamiento del cáncer de mama por parte de las mujeres con mastectomía. Se pudo dilucidar la importancia de la fe y la espiritualidad, el apoyo familiar y la participación en grupos de apoyo, a través del discurso de las participantes.

Introduction: When facing breast cancer, patients and their loving ones experiment many changes in their lives filled with feelings such as fear, anguish, and sadness. In the light of this, the identification of the coping methods used to face breast cancer is crucial to provide a better experience for all those involved. Objective: To understand the ways of coping with breast cancer through the discourse of mastectomized women in a support group. Methodology: Descriptive research with a qualitative approach carried out with 10 women who participate in a support group, located in a municipality in Paraíba, Brasil. For data collection, semi-structured interviews were conducted and as a methodological process for data analysis, the Collective Subject Discourse was used. Results: It was possible to understand three central coping mechanisms: ''Anchoring in faith and spirituality''; ''Family support'', and ''Support group''. Conclusion: The study reached its objective of identifying the main ways of coping with breast cancer by women who had mastectomies, their discourse highlighted the importance of faith and spirituality, the support of their families, and their participation in support groups.

Reconstrucción mamaria inmediata prepectoral / Immediate prepectoral breast reconstruction

Introducción. La reconstrucción mamaria inmediata con implantes prepectorales permite realizar la mastectomía oncológica con un resultado estético en un solo tiempo quirúrgico y con menor morbilidad del área dadora. Las indicaciones son precisas, en directa relación con las condiciones de la mastectomía. Material y métodos. Se presentan 83 pacientes en el período comprendido entre febrero de 2020 a febrero de 2022 con mastectomías uni- y bilaterales, con conservación del complejo areola-pezón los cuales fueron injertados en 7 casos. La incisión en surco submamario se realizó en 60 casos, radiada externa en 8 casos, vertical en 8 casos y 7 casos con patrón de reducción en el Instituto Oncológico Alexander Fleming. Los criterios de exclusión que utilizamos son tumores mamarios a menos de 1 cm del complejo areola pezón y tumores localmente avanzados. Resultados. En total se realizaron 98 mastectomías, de las cuales 86 fueron terapéuticas y 12 profilácticas por mutaciones genéticas. La extracción de ganglios se realizó por una incisión axilar, excepto en el patrón de reducción donde se realizó a través de la incisión de la mastectomía. En 42 pacientes se utilizaron implantes anatómicos y en 56 casos redondos texturizados. El seguimiento de las pacientes fue a 25 meses. Conclusión. La reconstrucción mamaria prepectoral lleva a la reconstrucción de la mama en el mismo espacio con una baja morbilidad y resultado natural. Las indicaciones para esta técnica deben ser muy precisas para lograr obtener los resultados deseados. En nuestra experiencia, la reconstrucción mamaria inmediata con implante directo es una técnica segura y reproducible, con excelentes resultados en pacientes en las que está debidamente indicada la técnica, con una baja tasa de complicaciones y disminución en el tiempo de tratamiento y de recuperación.

Introduction. Immediate breast reconstruction with pre pectoral implants allows to perform oncologic mastectomy with an aesthetic result in a single surgical time and with less morbidity of the donor area. The indications are precise and directly related to the conditions of the mastectomy. Material and methods. We present 83 patients in the period from February 2020 to February 2022 with uni and bilateral mastectomies, with preservation of the nipple-areola complex which was grafted in 7 cases. The incision in the submammary sulcus was performed in 60 cases, external radiated in 8 cases, vertical in 8 cases and 7 with reduction pattern at the Alexander Fleming Oncological Institute. The exclusion criteria we used are breast tumors less than 1 cm from the nipple areola complex and locally advanced tumors. Results. A total of 98 mastectomies were performed, of which 86 were therapeutic and 12 prophylactic for genetic mutations. Node removal was performed through an axillary incision, except in the reduction pattern where it was performed through the mastectomy incision. Anatomical implants were used in 42 patients and textured round implants in 56 cases. The follow-up of the patients was 25 months. Conclusion. Pre pectoral breast reconstruction leads to reconstruction of the breast in the same space with low morbidity and natural results. The indications for this technique must be very precise to achieve the desired results. In our experience, immediate breast reconstruction with direct implant is a safe and reproductible technique, with excellent results in patients in whom the technique is properly indicated, with a low rate of complications and decrease in treatment and recovery time.

Diagnósticos de enfermagem baseados na repercussão do câncer mamário e mastectomia / Nursing diagnoses based on breast cancer repercussion and mastectomy / Diagnósticos de enfermería basados en repercusión y mastectomía del cáncer de mama

Objetivo: Descrever diagnósticos de Enfermagem baseados nos discursos de mulheres sobre a repercussão do câncer mamário e mastectomia. Métodos: Trata-se de pesquisa descritiva, com abordagem qualitativa, realizada em uma Organização Não Governamental (ONG) no município de João Pessoa, Paraíba, Brasil. O universo amostral foi composto por todas as 15 mulheres mastectomizadas durante os meses de setembro e outubro de 2017. Essas mulheres responderam um roteiro de entrevista semiestruturada. A análise dos dados qualitativos foi norteada pela Técnica de Análise de Conteúdo proposta por Bardin. Após a delimitação das categorias, foram construídos diagnósticos de Enfermagem por meio da Classificação Internacional da Prática de Enfermagem (CIPE)®. Resultados: Foram identificadas três categorias temáticas: Sentimentos experenciados após diagnóstico de câncer e realização da mastectomia; Modificações biológicas e psicológicas após a mastectomia; Resiliência diante do sofrimento. Os diagnósticos de Enfermagem elencados foram: angústia, bem-estar prejudicado, bem-estar espiritual prejudicado, autoestima alterada, autoimagem alterada, capacidade de autocuidado prejudicada, dificuldades diárias, distúrbio da identidade pessoal, insatisfação com a vida e o corpo. Conclusão: é necessário enfatizar o cuidado no momento de verbalizar o diagnóstico, a escuta diante do outro e a percepção das mulheres diante do processo de adoecimento. (AU)

Objective: To describe nursing diagnoses based on women's discourse on the repercussions of breast cancer and mastectomy. Methods: This is a descriptive research, with a qualitative approach, carried out in a Non-Governmental Organization (NGO) in the city of João Pessoa, Paraíba, Brazil. The sample universe was composed of all 15 women undergoing mastectomy during the months of September and October 2017. These women answered a semi-structured interview script. The analysis of qualitative data was guided by the Content Analysis Technique proposed by Bardin. After delimiting the categories, Nursing diagnoses were constructed using the International Classification of Nursing Practice (ICNP) ®. Results: Three thematic categories were identified: Feelings experienced after cancer diagnosis and mastectomy; Biological and psychological changes after mastectomy; Resilience in the face of suffering. The nursing diagnoses listed were anguish, impaired well-being, impaired spiritual well-being, impaired self-esteem, impaired self-image, impaired self-care capacity, daily difficulties, personal identity disorder, dissatisfaction with life and body. Conclusion: it is necessary to emphasize care when verbalizing the diagnosis, listening to the other and the women's perception of the illness process. (AU)

Objetivo: Describir los diagnósticos de enfermería basados en el discurso de las mujeres sobre las repercusiones del cáncer de mama y la mastectomía. Métodos: Se trata de una investigación descriptiva, con enfoque cualitativo, realizada en una Organización No Gubernamental (ONG) en la ciudad de João Pessoa, Paraíba, Brasil. El universo muestral estuvo compuesto por las 15 mujeres sometidas a mastectomía durante los meses de septiembre y octubre de 2017. Estas mujeres respondieron un guión de entrevista semiestructurado. El análisis de datos cualitativos fue guiado por la Técnica de Análisis de Contenido propuesta por Bardin. Después de delimitar las categorías, los diagnósticos de enfermería se construyeron utilizando la Clasificación Internacional de la Práctica de Enfermería (CIPE) ®. Resultados: Se identificaron tres categorías temáticas: sentimientos experimentados después del diagnóstico de cáncer y mastectomía; Cambios biológicos y psicológicos después de la mastectomía; Resiliencia ante el sufrimiento. Los diagnósticos de enfermería enumerados fueron angustia, deterioro del bienestar, deterioro del bienestar espiritual, deterioro de la autoestima, deterioro de la autoimagen, deterioro de la capacidad de autocuidado, dificultades diarias, trastorno de la identidad personal, insatisfacción con la vida y el cuerpo. Conclusion: es necesario enfatizar el cuidado al verbalizar el diagnóstico, escuchar al otro y la percepción de la mujer sobre el proceso de la enfermedad. (AU)

Retrospective analysis of BI-RADS 4 and 5 lesions additionally detected by breast MRI / 中华外科杂志

Objectives: To establish a newly-designed scoring system for breast imaging-reporting and data system (BI-RADS) 4 and 5 breast lesions only visible on MRI, and to examine their clinical pathway of biopsy. Methods: The BI-RADS 4 and 5 breast lesions only visible on MRI but not suspected on mammograms or ultrasound between June 2007 and December 2021 at Beijing Hospital were evaluated retrospectively. A total of 209 lesions from 184 patients were finally included. All patients were female, aged (50±11) years (range: 27 to 76 years). All lesions were confirmed by pathology and divided into malignancy and non-malignancy. The lesions were divided into mass and non-mass type using BI-RADS. The receiver operator characteristic (ROC) curve was used to evaluate the diagnostic performance of the new scoring system. Four types of pathology-obtaining pathway were used: biopsy guided by second-look ultrasound, local excision guided by lesion position information on MRI, intraductal lesion excision guided by methylene blue stain and mastectomy. The data between mass and non-mass lesions were compared by Mann-Whitney U test, χ2 test or Fisher exact test,respectively. Results: There were 124 malignant and 85 non-malignant lesions, while 100 mass and 109 non-mass lessions. The sizes between mass and non-mass lesions showed significant difference(M(IQR)) (7.0 (3.0) mm vs. 25.0 (25.0) mm, U=568.000, P<0.01) and their BI-RADS diagnostic accuracy had no significant difference (53.0% (53/100) vs. 65.1% (71/109), χ2=3.184, P=0.074). The areas under ROC curve of the new scoring system for evaluating mass and non-mass were 0.841 and 0.802, respectively. When taking Score 3 as threshold, it can potentially avoid 14.0% (14/100) and 4.6% (5/109) of biopsies in mass and non-mass, respectively. As to pathway of obtaining pathology, second-look ultrasound succeeded more easily in mass than non-mass (41.0% (41/100) vs.26.6% (29/109), χ2=4.851, P=0.028). More MRI-guided local excisions were performed in non-mass than mass (52.3% (57/109) vs. 34.0% (34/100), χ2=7.100, P=0.008). Conclusions: For suspicious breast lesions detected by MRI but not suspected on X-ray or ultrasound, the new scoring system can further increase diagnostic accuracy. The second-look ultrasound plays an important role for obtaining pathology, especially for mass-type lesion.

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.

GMIA-Breast Oncoplastic and Reconstruction Society consensus on operative standards of breast cancer surgery / 南方医科大学学报

The Breast Cancer Surgery Operative Standards Consensus Conference aimed to establish industry technical standards and improve breast cancer surgery practices by addressing controversial and operative breast cancer surgery-related issues in clinical practice.The conference was led by the Breast Oncoplastic and Reconstruction Branch of Guangdong Medical Industry Association (GMIA) and involved 85 breast surgeons with expertise in breast cancer conserving, oncoplastic, and reconstructive surgery.Consensus was reached through 3 meetings.The first meeting brought up the topics of interest, and evidence summaries were presented for debate during the second meeting; the third meeting was held to reach consensus recommendation for selected topics.Pre-defined consensus criteria required that the consensus was reached only when more than 70% of the panelists agreed on the topic.Out of the 57 questions set for voting, 11 operative standards were recommended as Preferred, and one was recommended as Considered.Preferred operative standards included surgical details in breast conserving surgery, mastectomy, reconstructive surgery, surgical treatment of phyllodes tumor.Selected topics that did not reach consensus among the panelists were also discussed.These Preferred operative standards could help guide clinical surgical practice in routine patient care.

Peritumoral infiltration of local anesthetic before surgery in early breast cancer: a comment

This is a comment on a study recently published about peritumoral infiltration of local anesthetic before surgery in early breast cancer. Previously, animal models and a randomized study for stage IV breast cancer patients inferred that the removal of the primary tumor resulted in increased growth factors and worse distant disease control. Therefore, breast cancer surgery might not be a strictly local intervention. In this new randomized study, the intervention was a peritumoral infiltration of local anesthetic ­ lidocaine 0.5% in the six tumor margins, as an attempt to limit the systemic repercussions of surgery. Although the adjuvant treatment available for the study seems outdated, leading us to question the external validation, limited resources may have increased the power of surgery. Unknown mechanisms during surgery can change the patient's journey, and it is our duty to look at surgical studies with due seriousness

Impact of neoadjuvant chemotherapy in the surgical treatment of breast cancer

Introduction: Neoadjuvant chemotherapy is an increasingly frequent option in the treatment of breast cancer. One of the goals of neoadjuvant chemotherapy is to change the indication for a mastectomy to a conservative surgery, and for axillary lymphadenectomy to sentinel lymph node assessment. Methods: This was an observational, cross-sectional, retrospective study that evaluated response to neoadjuvant chemotherapy in breast cancer patients undergoing surgical treatment. Patients were divided into three groups when the surgery indication was changed after neoadjuvant chemotherapy: downgrade, unchanged, upgrade. Results: During the study period, 355 patients were included with a mean age of 55 years. Neoadjuvant chemotherapy promoted a downgrade in 38.7% of patients with indication for mastectomy and an upgrade in 36.8% of patients with indication for conservative surgery; in the total group, the maintenance of indication for surgery was 62,2%. In the axillary approach, lymphadenectomy downgrade was 6.9% and sentinel lymph node biopsy upgrade was 34% with 27% being due to positivity and 7% due to disease progression. Multivariate analysis found a significant difference between clinical staging and change in surgical indication for both breast and axilla (p<0.0001). In the multivariate analysis of pathologic complete response and change of indication for breast and axilla surgery, triple negative and HER-2-positive tumors showed a significant difference (p<0.0001). Conclusions: Neoadjuvant chemotherapy was able to perform a downgrade of breast and axilla surgery in few patients and there was no relationship between the change of indication and pathologic complete response. (AU)

Use of the serratus anterior fascia in immediate implant-based breast reconstruction

Using the serratus anterior fascia may be a safe and effective option to recreate the lateral breast profile during subpectoral breast reconstruction, with minimal functional impact on the donor site. However, the literature is scarce when it comes to studies on this fascia flap in implant-based reconstruction. This article aimed to review the use of the serratus anterior fascia in immediate implant-based breast reconstruction, searching the electronic databases PubMed, Embase, Lilacs, and SciELO. The search was carried out by combining the following keywords: 'breast reconstruction' and 'serratus anterior fascia'. In the Pubmed and Embase databases, the search yielded a total of 12 and 15 articles, respectively, of which seven were selected according to the scope of this article. We found no studies on serratus anterior fascia and breast reconstruction in the Lilacs and SciELO databases. All works have results favorable for the use of the serratus anterior fascia flap and agree that this technique can be considered in the algorithm for the coverage of the inferolateral portion during subpectoral breast reconstruction

Erysipelas after surgery for breast cancer: a real-world cohort

Erysipelas is often related to lymphedema, which can occur in up to 60% of cases, with advanced age, radiotherapy, tumor extension, surgical approach, and infections as risk factors. The aim of this study was to present and discuss a series of cases of erysipelas after breast cancer surgery treated in a private mastology clinic over the past ten years. This is a retrospective horizontal cohort study in which we selected all cases of erysipelas after breast cancer surgery from 2009 to 2019. The following were evaluated: number of patients treated with a diagnosis of breast carcinoma with axillary approach, age, surgery performed, adjuvant treatment and treatment of erysipelas, presence of lymphedema, and measurement of circumferences between both arms and associated diseases. A total of 12 cases of breast cancer were treated. In 66.66% of cases, a radical axillary lymphadenectomy was performed, and in 16.66% of cases, only a sentinel lymph node investigation was performed. The average age was 67.6 years. Erysipelas appeared, on average, 43 months after cancer diagnosis. Two deaths were reported due to severe erysipelas leading to sepsis. More studies are still needed on the subject. Of the 12 cases in this study, eight (66.66%) were associated with lymphedema. Only two (16.66%) of the patients in this group who developed erysipelas were not submitted to axillary dissection. The treatment for 50% of the participants in this research was with penicillin G benzathine. There were three relapses, and two patients died during the research period

Conhecimento de Fisioterapeutas não Especializados em Oncologia Mamária sobre Exercícios e Orientações no Pós-operatório do Câncer de Mama / Knowledge of Unskilled Breast Oncology Physical Therapists About Exercises and Guidelines in Postoperative Breast Cancer / Conocimiento de Fisioterapeutas no especializados en Oncología de Mama sobre Ejercicios y Directrices en el Posoperatorio de Cáncer de Mama

Introdução: O tratamento do câncer de mama pode gerar uma gama de comprometimentos físicos e psicológicos. A literatura atual sustenta que exercícios de amplitude livre permitem às pacientes boa recuperação funcional do ombro sem aumentar risco de complicações, e que exercícios resistidos progressivos são recomendados. Não há comprovação de que procedimentos no braço aumentem o risco de linfedema. Objetivo: Avaliar o conhecimento dos profissionais fisioterapeutas não especialistas nas áreas de oncologia e saúde da mulher quanto à conduta realizada em pacientes no período pós-operatório de câncer de mama. Método: Estudo observacional transversal, com dados coletados por questionário autopreenchido, sobre a atuação do fisioterapeuta em pacientes no período pós-operatório de câncer de mama. Resultados: Participaram do estudo 44 profissionais, 50,0% dos quais já haviam atendido pacientes em pós-operatório de câncer de mama, 47,7% acreditam que pacientes devem realizar mobilização ativa de membros superiores em até 90º de amplitude, não ultrapassando a linha do ombro em cirurgias sem reconstrução imediata, e 25% orientaram restrição a qualquer tipo de carga e/ou exercícios resistidos até liberação médica. A maior parte dos profissionais participantes da pesquisa orienta a não aferição de pressão arterial no membro homolateral à cirurgia e não puncionar acesso venoso periférico ou coletar exames no membro. Conclusão: A conduta adotada pela maior parte dos profissionais residentes e assistenciais analisados se baseia em recomendações desatualizadas sobre movimentação de membros, exercícios resistidos e prevenção de linfedema após cirurgia de câncer de mama

Introduction: Breast cancer treatment can cause physical and psychological impairments. The current literature advocates that exercises with free range of motion allow patients good functional recovery of the shoulder without increasing the risk of complications, and that progressive resistance exercises are recommended. There is no evidence that procedures on the arm increase the risk of lymphedema. Objective: To evaluate the knowledge of unskilled oncology and women's health physical therapists regarding the conduct adopted with patients post breast cancer surgery. Method: Prospective cross-sectional observational study carried out with a self-reported questionnaire on the physiotherapist's performance in the postoperative period of breast cancer. Results: Forty-four professionals participated in the study, 50% of which had already assisted patients in the postoperative period of breast cancer, 47.7% believe that patients should perform active mobilization of the upper limbs in up to 90º of amplitude, not exceeding the shoulder line in surgeries without immediate reconstruction and 25% advised restriction to any type of load and/or resistance exercises pending medical approval. Most of the professionals investigated advised not to measure blood pressure in the ipsilateral limb to the surgery and not puncture peripheral venous access or collect exams on the limb. Conclusion: The conduct adopted by most of the resident and caring professionals investigated is based in outdated recommendations on limb movements, resistance exercises and prevention of lymphedema post breast cancer surgery

Introducción: El tratamiento del cáncer de mama puede generar una serie de deterioros físicos y psicológicos. La literatura actual respalda que los ejercicios de amplitud libre permiten a las pacientes una buena recuperación funcional del hombro sin aumentar el riesgo de complicaciones, y que se recomiendan ejercicios de resistencia progresivos. No hay evidencia de que los procedimientos en el brazo aumenten el riesgo de linfedema. Objetivo:Evaluar el conocimiento de fisioterapeutas no especialistas en las áreas de oncología y salud de la mujer, sobre la conducta realizada a pacientes en el posoperatorio de cáncer de mama. Método: Estudio observacional transversal, con datos recogidos a través de un cuestionario autocompletado, sobre el papel de los fisioterapeutas en pacientes en el posoperatorio de cáncer de mama. Resultados: Participaron del estudio 44 profesionales, el 50,0% de los cuales ya había atendido a pacientes posoperados de cáncer de mama, el 47,7% cree que los pacientes deben realizar movilizaciones activas de los miembros superiores en hasta 90º de amplitud, no superando la línea del hombro en las cirugías. sin reconstrucción inmediata, y el 25% recomendó restricción a cualquier tipo de carga y/o ejercicios de resistencia hasta aprobación médica. La mayoría de los profesionales que participan en la investigación aconsejan no medir la presión arterial en el miembro ipsilateral a la cirugía y no perforar el acceso venoso periférico ni realizar exámenes en el miembro. Conclusión: La conducta adoptada por la mayoría de los residentes y profesionales asistenciales analizados se basa en recomendaciones obsoletas sobre movimiento de extremidades, ejercicios de resistencia y prevención del linfedema tras la cirugía de cáncer de mama

Angiosarcoma primario de mama. Reporte de caso y revisión de la literatura / Primary breast angiosarcoma. A case report and literature review

Introducción. El angiosarcoma primario de la mama es una neoplasia maligna derivada de las células endoteliales de los vasos sanguíneos, potencialmente agresiva independientemente de su grado histológico, por lo que su pronóstico es malo. Su diagnóstico prequirúrgico es difícil, ya que las características clínicas e imagenológicas son inespecíficas, y el diagnóstico definitivo únicamente se realiza por estudios de patología. Para su tratamiento generalmente se requiere de resección quirúrgica, radioterapia y, ocasionalmente, quimioterapia.Caso clínico. Paciente de 49 años sin antecedentes, que consultó por cuadro clínico de 5 meses de evolución de aparición y rápido crecimiento de masa en mama izquierda. Se realizaron estudios imagenológicos que reportaron lesión BIRADS 4a y diagnóstico histológico de lesión vascular con atipía, por lo cual fue llevada a mastectomía simple, con informe final de patología de angiosarcoma primario de mama; tuvo que ser reintervenida por márgenes positivos. Completó 33 ciclos de radioterapia y dos años después de la cirugía presentó cambios inflamatorios en la cicatriz quirúrgica, de la cual se tomó biopsia con reporte de lesión vascular atípica, por lo que fue operada nuevamente, con reporte histológico negativo para angiosarcoma residual. Actualmente la paciente está en seguimiento imagenológico, sin evidencia de recaída tumoral. Conclusión. Los angiosarcomas primarios de la mama son neoplasias raras y muy agresivas, independientemente de su grado histológico, por lo cual es importante hacer un diagnóstico histológico y tratamiento oncológico oportunos.

Introduction. Primary breast angiosarcoma is a malignant pathology derived from the endothelial cells of the blood vessels of the breast. They are potentially aggressive regardless of histological grade, reason why its prognosis is poor and treatment requires surgical resection plus radiation therapy and occasionally chemotherapy depending on the degree. Its pre-surgical diagnosis is difficult since the clinical and imaging characteristics are nonspecific, and the definitive diagnosis is only made by means of pathology studies. Clinical case. A 49-year-old patient was admitted to the breast surgery outpatient clinic due to clinical symptoms of 5 months of evolution consisting of the appearance of a painful mass in the left breast. Imaging of the lesion with ultrasound report BIRADS 4a and a tricot biopsy was taken with histological diagnosis of vascular lesion with atypia. It was decided to take the patient to a simple mastectomy, with a final report of breast angiosarcoma but with a margin compromised by a tumor for which she was reoperated. She received 33 cycles of radiotherapy and continued in follow-up for two years. During this period, the patient presented inflammatory changes in the surgical scar for which a punch biopsy was done with histological report of vascular atypical lesion. Surgical resection was performed with final report of negative pathology for residual angiosarcoma. Nowadays the patient continues imaging follow-up without evidence of a tumour relapse. Conclusion. Primary breast angiosarcomas are a rare malignant pathology, very aggressive regardless of its histological grade, for which it is important to perform a timely histological diagnosis and oncological treatment

Cambios en el estilo de vida de mujeres mastectomizadas / Lifestyle Changes in Mastectomized Women

Introducción: La mastectomía es una transformación dolorosa, con diversas repercusiones emocionales. La mujer que se enfrenta a este proceso a consecuencia del cáncer, se encuentra en una posición difícil, con pocas opciones, al considerar las posibilidades de continuar con su existencia y los cambios que esto implica. Objetivo: Conocer los cambios de estilo de vida que experimentan las mujeres con cáncer de mama después de la mastectomía. Métodos: Estudio cualitativo con diseño interpretativo, realizado en la Unidad de Oncología del Hospital Regional de Lambayeque, Chiclayo, Perú, de enero a junio de 2021. Por muestreo no probabilístico, fueron seleccionadas seis mujeres mastectomizadas, mayores de 18 años, con seguimiento en consulta mayor de un año y un familiar conviviente mayor de 18 años. Los datos se obtuvieron mediante entrevista semiestructurada y fueron analizados según el modelo de adaptación de Callista Roy. Resultados: La información recogida se categorizó, en correspondencia a cada elemento del modelo de adaptación de Callista Roy, en: necesidad fisiológica, cambios en la alimentación, dominio de rol, cambios en el rol de madre y esposa, y en interdependencia: las relaciones con los que la rodean (amigos, familia) y el aspecto laboral-profesional. Se destacaron cambios drásticos en la selección de alimentos, aislamiento, reducción de actividades; efecto en la carga laboral; importancia del apoyo familiar. Conclusión: El cáncer y la mastectomía exigen adaptaciones en la paciente y la familia. Sin embargo, ocurren transformaciones afectivas, que mueven sentimientos, valoración, admiración y acercamiento, que refuerzan los vínculos de pareja, familiares y de amigos, tan necesarios para lidiar con el proceso(AU)

Introduction: Mastectomy is a painful transformation, with diverse emotional repercussions. The woman who faces this process as a consequence of cancer finds herself in a difficult position, with few options, when considering the possibilities of continuing with her existence and the changes this implies. Objective: To know the lifestyle changes experienced by women with breast cancer after mastectomy. Methods: Qualitative study with interpretative design, conducted in the Oncology Unit of the Regional Hospital of Lambayeque, Chiclayo, Peru, from January to June 2021. By non-probabilistic sampling, six mastectomized women, older than 18 years, with a follow-up in consultation of more than one year and a cohabiting relative older than 18 years were selected. The data were obtained by semi-structured interview and were analyzed according to Callista Roy's adaptation model. Results: The information collected was categorized, according to each element of Callista Roy's adaptation model, as follows: physiological need, changes in diet, role dominance, changes in the role of mother and wife, and interdependence: relationships with those around her (friends, family) and the work-professional aspect. Drastic changes in food selection, isolation, reduction of activities; effect on workload; importance of family support were highlighted. Conclusion: Cancer and mastectomy require adaptations in the patient and family. However, emotional transformations occur, which move feelings, appreciation, admiration and closeness, which reinforce the couple, family and friends bonds, so necessary to deal with the process(AU)

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center / Desfechos oncológicos da mastectomia poupadora do complexo areolo-mamilar em uma população não selecionada avaliada em um único centro

Abstract Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

Resumo Objetivo A mastectomia poupadora do complexo areolo-mamilar (MPM) tem sido tradicionalmente utilizada em casos selecionados com distância tumor-mamilo > 2 cm e biópsia de congelação da base do mamilo negativa. Recomendar MPM em populações não selecionadas continua controverso. Este estudo avaliou os resultados oncológicos de pacientes submetidas à MPM em uma população não selecionada atendida em um único centro. Métodos Coorte retrospectivo incluindo pacientes não selecionadas com carcinoma invasivo ou carcinoma ductal in situ (CDIS) submetidas à MPM entre 2010 e 2020. Os desfechos incluíram: recorrência locorregional, sobrevida livre de doença (SLD) e sobrevida global (SG), independentemente do tamanho do tumor ou da distância tumor-mamilo. Resultados Setenta e seis pacientes (média: 46,1 anos de idade) (58 carcinomas invasivos/18 CDIS) foram incluídas. A maioria dos carcinomas invasivos era hormônio-positivo (60%) (superexpressão de HER2: 24%; triplo-negativo: 16%), enquanto 39% dos CDIS eram de alto grau histológico. Os carcinomas invasivos foram T2 em 66% dos casos, com metástases axilares em 38%. As margens cirúrgicas foram todas negativas. Todas as pacientes com carcinoma invasivo receberam tratamento sistêmico e 38% receberam radioterapia. Após um período médio de 34,8 meses, 3 pacientes com carcinoma invasivo (5,1%) e 1 com CDIS (5,5%) apresentaram recidiva local. Durante o acompanhamento, duas pacientes tiveram metástase à distância e vieram a óbito. As taxas de SG e SLD aos 5 anos para carcinoma invasivo foram de 98% e 83%, respectivamente. Conclusão Em casos não selecionados, os resultados oncológicos de 5 anos após MPM foram considerados aceitáveis e comparáveis a resultados anteriores. Estudos adicionais são necessários.