Patients' satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap.

Immediate breast reconstruction with a latissimus dorsi musculocutaneous (LDM) flap is still not much reported, particularly in studies of patients' views. The aim of this study was to assess the level of patients' satisfaction with the technique. All patients (n = 257) who had had a mastectomy and immediate breast reconstruction with a LDM flap at a single hospital between January 1999 and December 2005 were identified, and 196 patients free of recurrence were included. The operations were done by the same surgical team in a standard manner. Clinical data, technical details, and outcome were collected prospectively. To assess the patients' degree of satisfaction with the aesthetic results in relation to clinical characteristics and treatment, a study-specific questionnaire and a visual analogue scale were sent to 196 patients; 178 forms were completed and returned. To analyse general satisfaction and aesthetic results we used the Mann-Whitney, Kruskal-Wallis, chi square, or Fisher's exact test, as appropriate. The median reconstruction follow-up period was 34 months. Patients who were 51 years or older at the time of reconstruction were less likely to opt for immediate breast reconstruction with LDM flap than younger patients. Patients who were divorced and those who had postoperative complications were less likely to be satisfied. One hundred and sixty-four patients (92%) were satisfied, and 161 (90%) said they would recommend the reconstruction. The median satisfaction score was 9 (range 1-10, mean 8.5). The technique provided satisfactory immediate breast reconstruction according to the patients' evaluation.

Glycosaminoglycans of abdominal skin after massive weight loss in post-bariatric female patients.

BACKGROUND: The number of post-bariatric patients had a significant increase over the last years, and a better understanding of the consequences of massive weight loss on skin is imperative. Despite weight-loss-related changes in collagen and elastin have been reported, less is known about changes in another of the matrix components of the skin, the glycosaminoglycans. The objective of this study is to evaluate abdominal skin glycosaminoglycans concentrations and perlecan and collagen III expression in post-bariatric female patients. METHODS: Skin tissue samples from the abdomen of lean (n = 19) and post-bariatric (n = 24) female patients were compared. Sulfated glycosaminoglycans and hyaluronic acid were extracted, characterized and quantified. Perlecan and collagen III expression was assessed by immunofluorescence. RESULTS: The major glycosaminoglycans found were dermatan sultafe and hyaluronic acid; the others were found in smaller amounts. The skin of the post-bariatric patients had lower concentrations of heparan sulfate (p = 0.002) while hyaluronic acid, dermatan sulfate, and chondroitin sulfate concentrations were similar to the lean women's skin. Post-bariatric skin showed decreased expression of perlecan and increased expression of collagen III. No correlation was found among glycosaminoglycans concentrations and age, body mass index, frequency of pregnancies, or skin types, but it was observed in higher skin heparan sulfate concentrations in post-bariatric patients who had their weights stabilized for over than 24 months (p = 0.000). CONCLUSION: Abdominal skin of post-bariatric women presented decreased heparan sulfate concentrations and perlecan expression and increased expression of collagen III.

Quilting suture in the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction.

BACKGROUND: The purpose of this study was to evaluate the effects of quilting suture (placement of stitches between the superficial fascia in the supraumbilical remaining flap and the musculoaponeurotic layer of the anterior abdominal wall) at the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction. METHODS: There is a theory that the use of quilting suture, during the closure of the donor site with the abdominal flap, causes collapse of the dead space and enables the flap to rest, thus diminishing factors that may interfere in its adherence and help to reduce complications. Between January 2004 and March 2005, we performed 30 breast reconstructions using a unipedicled transverse rectus abdominis musculocutaneous flap. The sample was randomly distributed in 2 groups: 15 patients with quilting suture (group A) and 15 patients without quilting suture (group B). The study focused on daily drain output (mL), time to drain removal (days), and possible donor site complications (%). RESULTS: Group A presented an average of 4.2 days for removal of the drain and group B, 6.93 days, with a statistically significant difference (P < 0.001). Concerning the total volume upon removal of the drain, group A presented an average of 434.7 mL and group B, 620.7 mL, with a statistically significant difference (P = 0.002). Group A presented 13.3% complications at the donor site and group B, 53.3%, with a statistically significant difference (P = 0.05). CONCLUSIONS: The quilting suture in this study reduces the permanence of drains, total volume of tissue fluids upon drain removal, and complication rates.

Histologic analysis of zafirlukast's effect on capsule formation around silicone implants.

BACKGROUND: The most common complication experienced by patients who have undergone mammary implant surgery is capsular contracture. This matter concerns physicians and patients, but to date, there is no effective way to avoid this complication. Surgical intervention usually is required. In 2002, the use of zafirlukast, a leukotriene inhibitor (a drug used for asthma treatment), was reported for the treatment of capsular contracture, with good results. METHODS: For this study, 30 female Wistar rats were used. These animals received two silicone implants each: one with a smooth surface and one with a textured surface. All the animals received daily intraperitoneal injections for 90 days and were divided as follows: control group (C) receiving only saline solution, experimental group 1 (E-I) receiving 1.25 mg/kg/day of zafirlukast, and experimental group 2 (E-II) receiving 5 mg/kg/day of zafirlukast. Histologic analysis used hematoxilin and eosin to verify vessels, capsule thickness, and inflammatory cells. Immunoistochemical analysis with smooth muscle anti-actin antibody was used for myofibroblast verification. Picro-Sirius under polarized light was used for collagen analysis. RESULTS: Textured implant experimental groups presented smaller numbers of vessels, thinner capsules, lower collagen density, and smaller numbers of mastocytes and eosinophils than the control group. No significant differences were found in smooth surface implants, as compared with the control group. CONCLUSION: Zafirlukast reduced the occurrence of factors directly and indirectly connected with capsular contracture.

Qualidade de vida após tratamento da assimetria mamária / Quality of life after surgical treatment of primary breast asymmetry

Objetivos: Avaliar o impacto do tratamento cirúrgico da ssimetria mamária primária na qualidade de vida. Métodos: Foi aplicado, pré-operatório e aos 3 e 6 meses após mastoplastia , o questionário genérico de qualidade de vida, "Medical Outcomes Study 36-item Short Form Health Survey" (SF-36), o qual avalia qualidade de vida em oito domínios (capacidade funcional, aspectos físicos, dor, estado geral de saúde, vitalidade, aspectos sociais, aspecto emocional e saúde mental). Resultados: Houve alterações positivas estatisticamente significativas em quatro dos oito aspectos avaliados pelo SF-36. As diferenças em relação ao pré-operatório foram: nos aspectos emocionais, no 3º mês pós-operatório, e no 6º mês pós-operatório, na dor, vitalidade e saúde mental. Conclusões: O tratamento cirúrgico da assimetria mamária promoveu um impacto positivo na qualidade de vida das pacientes.