Exploring the Ideal of Breast Beauty: A Morphometric Analysis Based on the Opinions of the Brazilian Population.

Background The quest to identify parameters deemed optimal for breast aesthetics holds paramount significance in both aesthetic and reconstructive surgery. The definition of ideal breast beauty, however, is subject to cultural variations and diverse standards, necessitating a detailed understanding. Objective This study delves into the perspectives of the Brazilian population regarding the aesthetics of the female breast. Methods A selection of images portraying variations in the distribution of upper and lower pole ratios across four distinct proportion models (35:65, 45:55, 50:50, and 55:45) was presented to participants. Through a meticulously crafted questionnaire administered via Google Forms, respondents were tasked with identifying the images they deemed most beautiful and attractive. Comprehensive demographic data of the study participants were gathered and subsequently correlated with their group-specific opinions. Results A total of 3744 questionnaire responses were collected 228 of which were from plastic surgeons/residents. The average age was 35 years, with 55.3% being women. Notably, breasts featuring a ratio of 45:55 emerged as the consensus choice for the epitome of beauty, garnering preference from 73% of the general population, 68% of women, 78% of men, and an equal 78% of plastic surgeons. This preference was consistent across all regions of the country. Conclusion Breasts with a ratio of 45:55 were universally deemed the most aesthetically pleasing. Similarly, breasts with a 50:50 ratio of breast tissue emerged as the next preferred choice. These insights contribute valuable perspectives on aesthetic considerations in breast surgery within the unique cultural context of Brazil.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Genital Self-Image and Body Dysmorphic Disorder Symptoms in Patients Undergoing Central Wedge vs. Linear Resection Labiaplasty: A Randomized Clinical Trial.

BACKGROUND: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder. Brazil stands as the global leader in the prevalence of labiaplasty procedures. OBJECTIVE: This study aimed to assess alterations in genital self-image and symptoms of body dysmorphic disorder in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty. METHODS: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with two parallel groups. Allocation ratio was 1:1. The Study Group (SG) underwent wedge labiaplasty, while the Control Group (CG) underwent trim labiaplasty. Genital self-image and symptoms of body dysmorphic disorder were assessed both preoperatively and six months postoperatively, using validated tools. RESULTS: After a six-month intervention period, a statistically significant improvement in genital self-image was observed (p<0.001), alongside a marked decrease in the score of symptoms related to body dysmorphic disorder (p<0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique employed. CONCLUSION: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of body dysmorphic disorder, evident in both the wedge and linear labiaplasty groups at the six-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes.

Congenital and acquired symmastia: a novel correction technique.

BACKGROUND: Symmastia, first defined by Spence in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach, preoperative, and postoperative care for the correction of symmastia. METHODS: Between January 2014 and December 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. RESULTS: All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. CONCLUSION: The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes.

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant / Produção de secreção leitosa após reconstrução mamária tardia com retalho musculocutâneo de latíssimo do dorso com implante

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

Aesthetic Contouring of the Chest wall with Rib Resection.

BACKGROUND: In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes. METHODS: A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details. CONCLUSIONS: Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prevalence of Body Dysmorphic Disorder Symptoms and Body Weight Concerns in Patients Seeking Abdominoplasty.

BACKGROUND: Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery, and body contouring surgery is most frequently sought by patients with BDD. OBJECTIVES: To estimate the prevalence and severity of BDD symptoms in patients seeking abdominoplasty. METHODS: Ninety patients of both sexes were preoperatively divided into two groups: patients with BDD symptoms (n = 51) and those without BDD symptoms (n = 39) based both on the Body Dysmorphic Disorder Examination (BDDE) and clinical assessment. Patients in the BDD group were classified as having mild to moderate or severe symptoms, according to the BDDE. Body weight and shape concerns were assessed using the Body Shape Questionnaire (BSQ). RESULTS: The prevalence of BDD symptoms was 57%. There were significant associations between BDD symptoms and degree of body dissatisfaction, level of preoccupation with physical appearance, and avoidance behaviors. Mild to moderate and severe symptoms of BDD were present in 41% and 59% of patients, respectively, in the BDD group. It was found that the more severe the symptoms of BDD, the higher the level of concern with body weight and shape (P < .001). Patients having distorted self-perception of body shape, or distorted comparative perception of body image were respectively 3.67 or 5.93 times more likely to show more severe symptoms of BDD than those with a more accurate perception. CONCLUSIONS: Candidates for abdominoplasty had a high prevalence of BDD symptoms, and body weight and shape concerns were associated with increased symptom severity.

Quality of Life and Sleep of a Multidisciplinary Team in the Burns Treatment Unit of Hospital São Paulo / Qualidade de vida e de sono da equipe multidisciplinar na Unidade de Tratamento de Queimaduras do Hospital São Paulo

Introdução: O objetivo foi avaliar a qualidade de vida e do sono da equipe multidisciplinar da Unidade de Tratamento de Queimaduras. Métodos: O questionário Short Form-36 Medical Outcomes Survey (SF-36) e o Pittsburgh Sleep Quality Index (PSQI) foram utilizados em 50 trabalhadores da unidade. Resultados: A limitação dos aspectos físicos, da saúde geral, da vitalidade e da limitação da saúde social e mental foram significativamente correlacionada com o sono (p<0,05). Conclusões: Esse ambiente de trabalho não é propício para o autocuidado dos trabalhadores; ao contrário, é um lugar de mobilização para emoçõoes e para o estresse.

Background: The aim of this study was to assess the quality of life and sleep of the multidisciplinary team of the Burn Unit. Methods: The Short Form-36 Medical Outcomes Survey (SF-36) and Pittsburgh Sleep Quality Index (PSQI) were used in 50 workers. Results: The limitation of the physical aspects, the general health, vitality, and limitation of social and mental health were significantly correlated with sleep (p<0.05). Conclusions: The work environment is not conducive to workers' self-care; rather, it is a mobilizing place for emotions and stress.

Compreendendo a psicopatologia do transtorno dismórfico corporal de pacientes de cirurgia plástica: resumo da literatura / Understanding the psychopathology of body dysmorphic disorder in cosmetic surgery patients: a literature review

INTRODUÇÃO: Indivíduos com Transtorno Dismórfico Corporal (TDC) buscam a cirurgia estética para corrigir um defeito percebido. A prevalência de TDC entre pacientes de cirurgia plástica varia de 6% a 24%, podendo chegar a 53%. Recentemente, estudos foram realizados para identificar a fisiopatologia dos sintomas de TDC através de neuroimagem, assim como a relação entre TDC e outros transtornos (por exemplo, transtorno obsessivo-compulsivo, anorexia nervosa, ansiedade social, e transtorno de somatização), e para distinguir convicções delirantes de não-delirantes como uma expressão de um único transtorno mental com diferentes níveis de gravidade. Entretanto, estudos retrospectivos sugerem que pacientes com TDC não se beneficiam com cirurgia plástica. O objetivo deste artigo foi fornecer uma visão geral da pesquisa atual sobre TDC e identificar características psicopatológicas do TDC em pacientes de cirurgia plástica. MÉTODO: Realizou-se uma busca nas bases de dados PubMed e Embase cruzando as palavas-chave "cirurgia plástica" "cirurgia estética" e "transtorno dismórfico corporal". RESULTADOS: A prevalência de TDC é alta entre pacientes de cirurgia plástica. Não há estudos prospectivos sobre o impacto da cirurgia plástica em pacientes com TDC. CONCLUSÃO: TDC precisa ser adequadamente identificado na seleção de pacientes para cirurgia plástica a fim de otimizar a gestão de atendimento e a qualidade de vida de pacientes com TDC.

INTRODUCTION: Individuals with Body Dysmorphic Disorder (BDD) may seek cosmetic surgery to correct a perceived defect. BDD prevalences ranging from 6% to 24% and up to 53% have been reported among cosmetic surgery patients. Recent studies have been conducted to identify the pathophysiology of BDD symptoms using neuroimaging, as well as the relationship of BDD to other disorders (e.g., obsessive-compulsive disorder, anorexia nervosa, social anxiety, and somatization disorder), and means to distinguish delusional from non-delusional beliefs as an expression of a single mental disorder at different severity levels. Retrospective studies have however suggested that BDD patients do not benefit from cosmetic surgery. This paper aimed at providing an overview of the current research on BDD and identifying psychopathological characteristics of BDD in cosmetic surgery patients. METHODS: The PubMed and Embase databases were searched by crossing the keywords "plastic surgery", "aesthetic surgery" and "body dysmorphic disorder". RESULTS: The prevalence of BDD was high among cosmetic surgery patients. No prospective studies were found on the impact of cosmetic surgery on BDD patients. CONCLUSION: BDD needs to be adequately assessed during patient selection for cosmetic surgery to optimize the quality of care provided and the quality of life of patients with BDD.