RESUMO
BACKGROUND: The introduction of enhanced recovery after surgery (ERAS) protocols has revolutionized preoperative and postoperative care. To date, however, the principles of enhanced recovery have not been applied specifically to patients undergoing breast surgery. METHODS: Based on the core features of ERAS, individual aspects of postoperative care in breast surgery were defined. A comprehensive search of MEDLINE, PubMed, Embase and the Cochrane Library database was performed from 1980 to 2010 to determine the best evidence for perioperative care in oncological breast surgery. A graded recommendation based on the best level of evidence was then proposed for each feature of ERAS. RESULTS: Twelve core features of enhanced recovery after breast surgery were identified. Use of the thoracic block, from both analgesic and anaesthetic viewpoints, is well supported by evidence and should be encouraged. Trials specific to breast surgery regarding aspects such as perioperative fasting, preanaesthetic medication, prevention of hypothermia and postdischarge support are scarce, and evidence was extrapolated from non-breast trials. Trials on postoperative analgesia and prevention of postoperative nausea and vomiting in breast surgery are generally of small numbers. In addition, there is heterogeneity between studies. CONCLUSION: This review suggests that the principles of enhanced recovery can be adopted in breast surgery. A 12-point protocol is proposed for prospective evaluation.
Assuntos
Doenças Mamárias/cirurgia , Mama/cirurgia , Protocolos Clínicos , Analgesia/métodos , Analgésicos/uso terapêutico , Anestesia Geral/métodos , Ansiolíticos/uso terapêutico , Antibioticoprofilaxia/métodos , Antieméticos/uso terapêutico , Ansiedade/prevenção & controle , Aconselhamento , Drenagem/métodos , Deambulação Precoce , Medicina Baseada em Evidências , Jejum , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Alta do Paciente , Educação de Pacientes como Assunto , Náusea e Vômito Pós-Operatórios/prevenção & controle , Cuidados Pré-Operatórios/métodos , Prognóstico , Adesivos Teciduais/uso terapêutico , Trombose Venosa/prevenção & controleRESUMO
BACKGROUND: Autologous fat transplantation has been used to correct cosmetic deformities in almost all areas of the body. In recent years, there has been a resurgence of interest in the use of fatty tissue to fill defects resulting from breast conserving surgery (BCS) and asymmetries after reconstructive breast surgery. METHODS: A Medline database search was performed, and the published evidence was reviewed. RESULTS & CONCLUSION: We describe and discuss the technique and indications, advantages, disadvantages and future direction of fat transfer to the breast. SEARCH METHODOLOGY: A Medline database search was used to retrieve relevant literature. Key search words used were: breast fat transfer, fat auto-transplantation, adipose tissue injection and lipomodelling. As a number of original articles are in French these were translated and used in addition to the English publications.
