Breast reconstruction for locally advanced breast cancer previously submitted to mastectomy and an ipsilateral thoracoabdominal dermofat (ITADE) flap.

Thoracoabdominal (TA) flaps are a good option for primary closure of small and medium defects after mastectomy for locally advanced breast tumours. Although they have a higher rate of necrosis than myocutaneous flaps, they can be easily performed by breast surgeons. Few studies on this procedure have been reported, and we have been unable to identify any prior publications reporting breast reconstruction with TA flaps.

Surgical management of locally advanced breast cancer: Recommendations of the Brazilian Society of Surgical Oncology.

The Brazilian Society of Surgical Oncology organized a group of oncological surgeons to discuss surgical aspects associated with locally advanced breast carcinoma. This article reviews the indications, different surgeries (thoracoabdominal or myocutaneous flaps), and associated complications. It discusses special conditions such as invasion of the chest wall and interscapular thoracic disarticulation. It makes recommendations based on the literature regarding clinical findings, tumor conditions, response to neoadjuvant therapy, choice of flaps in surgery, and tumor biology.

Reconstrucción mamaria posmastectomía en el Instituto Nacional de Oncología y Radiobiología de Cuba (2008-2012) / Post-mastectomy breast reconstruction at the National Institute of Oncology and Radiobiology in Cuba (2008-2012)

Introducción: el impacto psicológico causado por la cirugía radical de la mama afecta la percepción de la propia imagen, y lo hace sumado al daño causado por la propia enfermedad. Este estudio tuvo como objetivo caracterizar experiencias en la reconstrucción mamaria posmastectomía. Métodos: se realizó un estudio prospectivo para caracterizar la experiencia en la reconstrucción mamaria posmastectomía en pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología entre enero de 2008 y diciembre de 2012. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 30 y 49 años. Predominaron los estadios I y II, y el carcinoma ductal infiltrante fue el más frecuente. Se realizó con mayor frecuencia la reconstrucción con expansión tisular, y le siguieron en frecuencia la reconstrucción con músculo dorsal ancho y la reconstrucción con músculo recto abdominal transverso (TRAM). El tipo de reconstrucción diferida fue la predominante, y en el tratamiento de la mama contralateral la técnica más empleada fue la mastoplastia reductora. Las principales complicaciones estuvieron relacionadas con la técnica empleada. Conclusiones: todas las mujeres pudieron someterse a la reconstrucción mamaria, y las técnicas quirúrgicas fueron aplicadas según las características específicas de cada paciente.

Introduction: the psychological impact of radical surgery of the breast affects the perception of the self-image in addition to the damage caused by the disease as such. This study was aimed at characterizing the experiences gained in post-mastectomy breast reconstruction. Methods: a prospective study was conducted to characterize the experiences gained in breast reconstruction after mastectomy in female patients seen at the National Institute of Oncology and Radiobiology from January 2008 through December 2012. Results: the predominant age group comprised women aged 30-49 years in I and II stagings, being the infiltrating ductal carcinoma the most frequent one. Reconstruction with tissue expansion was mostly performed, followed by reconstruction with wide dorsal muscle and reconstruction with transverse rectum abdominal muscle. The type of differed reconstruction was predominant. In the contralateral breast treatment, the most used technique was reductive mastoplasty. The main complications were associated to the type of surgical technique. Conclusions: all the operated women underwent breast reconstruction and the surgical techniques depended on the specific characteristics of each patient.

Reconstrução mamária com retalho dermogorduroso de pedículo inferior associado ao músculo peitoral / Breast reconstruction with pedicle fat dermal layer associated pectorallis muscle flap

Introdução: A mastectomia é o tratamento padrão para todos os tipos de câncer (CA) de mama. Essa doença, com exceção dos cânceres de pele não melanoma, ocupa o primeiro lugar dos cânceres que acometem as mulheres. Muitas são as possibilidades de reconstrução para mastectomia total, envolvendo retalhos autólogos e colocação de implantes. Os avanços na utilização dessas técnicas têm sido aprimorado ao longo dos anos de forma a proporcionar excelentes resultados. O objetivo deste trabalho é a descrição da técnica de reconstrução mamária com retalho dermogorduroso de pedículo inferior associado ao músculo peitoral e análise dos resultados. Métodos: Foi realizada análise retrospectiva de prontuários das pacientes operadas para tratamento de câncer de mama, no período de 2008 a 2013, na clínica privada do autor. Foram selecionadas todas as pacientes que apresentavam tumores localizados nos quadrantes superiores. Resultados: No período analisado, 210 pacientes foram submetidas à reconstrução mamária. Destas, 17 (8,09 %) foram submetidas à reconstrução de mama pela técnica proposta. Com relação às complicações pós-operatórias, observou-se 1 caso de necrose da pele e 1 caso de assimetria. Conclusão: Além de tecnicamente simples e com resultados estéticos aceitáveis, o retalho proposto não acarreta em morbidade de sítio doador, recuperação prolongada, fraqueza muscular com a vantagem de, na maioria das vezes, ser realizado em um único tempo cirúrgico.

Introduction: A mastectomy is the standard treatment for all types of breast cancer (CA). This disease, with the exception of non-melanoma skin cancers, ranks first cancers that affect women. Many are the possibilities for full mastectomy reconstruction, involving autologous flaps and implant placement. Advances in the use of these techniques have been refined over the years in order to provide excellent results.The aim of this study is to describe the technique of breast reconstruction with the fat dermal inferior pedicle flap associated with pectoral and analysis of postoperative results. Methods: Retrospective analysis of medical records of patients operated for treatment of breast cancer in the period 2008-2013, in the private practice of the author and all patients had tumors located in the upper quadrants were selected was performed. Results: Over this period, 210 patients underwent breast reconstruction. Of these, 17 (8.09%) underwent breast reconstruction by the proposed technique. Over this period, 210 patients underwent breast reconstruction. Of these, 17 (8.09%) underwent breast reconstruction by the proposed technique. Regarding postoperative complications, there was 1 case of skin necrosis and 1 case of asymmetry. Conclusions: Apart from technically simple and acceptable cosmetic results, the proposed flap does not result in donor site morbidity, prolonged recovery, muscle weakness with the advantage that, in most cases, be accomplished in a single operation.

Reconstrucción mamaria en pacientes con patología mamaria / Breast reconstruction in patients with mammary pathology

El cáncer de mama en Cuba constituye la mayor tasa de incidencia de esta enfermedad en el sexo femenino y la segunda causa de muerte. Como resultado del tratamiento quirúrgico se realiza la mastectomía. De esta circunstancia se deriva la preocupación de las pacientes por ser sometidas a la cirugía reconstructiva. En este trabajo se presentan 3 casos de mujeres mastectomizadas por cáncer y por enfermedad benigna de comportamiento agresivo, tratados en el servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología, entre marzo de 2010 y marzo de 2012. A cada paciente se le realizó la reconstrucción mamaria empleando la técnica quirúrgica disponible que fuera más conveniente, según su caso. Se utilizaron como técnicas quirúrgicas: la expansión tisular, el colgajo miocutáneo de dorsal ancho y el TRAM (transverse rectus abdominals myocutaneous). Se pudieron reconstruir todos los casos con adecuados resultados estéticos. Se demostró las ventajas de la reconstrucción mamaria y la vigencia de los colgajos miocutáneos(AU)

Breast cancer represents the highest incidence rate of this disease and the second cause of death in the female sex. Mastectomy is preformed as a result of surgical treatment. It causes patient's worry about undergoing reconstructive surgery. In this work, three cases of women who underwent mastectomies because they were suffering from cancer and benign diseases of aggressive behavior were presented. These women were treated in the Reconstructive Surgery Service of the National Institute of Oncology and Radiobiology from March 2010 to March 2012. Mammary reconstruction was performed in each patient, applying the most convenient surgical technique, according to the case. Surgical techniques such as tissular expansion, the latissimus dorsi myocutaneous flap, and the TRAM (transverse rectus abdominis myocutaneous) were used. All cases could be reconstructed, achieving good aesthetic results. The advantages of mammary reconstruction and the validity of myocutaneous flaps were demonstrated(AU)

Uso del colgajo del músculo recto anterior del abdomen (tram) en reconstrucción mamaria inmediata / Use of the flap of the rectus abdominis (tram) in immediate mammary econstruction

Estudio realizado en el hospital oncológico “Dr. Juan Tanca Marengo” (SOLCA) en pacientes sometidas a reconstrucción mamaria inmediata (RMI). Tipo de estudio: retrospectivo, analítico, descriptivo. Objetivos: describir y analizar diferentes técnicas quirúrgicas empleadas en reconstrucción mamaria postmastectomía. Comparar distintos procedimientos de RM según el material usado en cuanto a complicaciones y resultado estético. Determinar el método reconstructivo más adecuado y aceptado por la paciente. Resultados: de 112 pacientes sometidas a RMI postmastectomía por cáncer de mama, en el hospital oncológico “Dr. Juan Tanca Marengo” (SOLCA) durante 1994 - 2004, 12 fueron excluídas al ser mastectomizadas por otro motivo o por falta de seguimiento postquirúrgico. Además, la práctica inmediata de reconstrucción mamaria fue la más frecuente, siendo los tejidos autólogos (TRAM), la técnica más utilizada (79.8) ya que sus complicaciones (36.5), fueron menores que con agentes heterólogos, 69 sea con implantes y/o expansores. En cuanto al resultado estético con TRAM fue evaluado como excelente por la misma paciente (56) y médico encargado (52). Conclusión: estos resultados demuestran la importancia de capacitar y entrenar a los cirujanos en RM para brindarles a las mujeres mastectomizadas una nueva opción con buenos resultados.

Study carried out in the oncologic hospital “Dr. Juan Tanca Marengo” (SOLCA) inpatients subjected to immediate mammary reconstruction (IMR). Study type: retrospective, analytical, descriptive. Objectives: describe and analyze different surgical techniques used in post-mastectomy. Mammary reconstruction. Compare different procedures of MR according to the material used regarding complications and esthetic result. Determine the most appropriate and accepted by the patient reconstructive method. Results: 12 patients out of 112 subjected to post-mastectomy IMR due to mammary cancer in the oncologic hospital “Dr. Juan Tanca Marengo” (SOLCA) from 1994 to 2004, were excluded because they had mastectomy for other reasons or lack of post-surgical follow up. Additionally, the immediate mammary reconstruction was the most frequent, and the most used technique the autologous tissues –TRAM - (79.8), since its complications (36.5) were lesser than with heterologous agents (69), be it with implanting and/or expanders. Regarding the estheticresult with TRAM, it was evaluated as excellent by the patient herself (56) and doctor in charge (52). Conclusion: these results prove the importance of preparing and training RM surgeons to offer to women that had mastectomy a new option with good results.