Treatment and Prevention of Umbilical Sagging with Laser-assisted Liposuction: The New Happy Protocol.

Sagging of the periumbilical skin, also known as the "sad umbilicus," is one of the most common postoperative complications in liposuction. It is characterized by an increase in the width and decrease in the height of the umbilicus. Technological advances in power-assisted liposuction resulting in skin tightening have been central to improvements in the treatment of sagging skin. Laser-assisted liposuction is a procedure in which a laser fiber induces lipolysis and skin tightening. Laser treatment delivered using a 980-nm diode laser may result in up to 30% skin surface area contraction. The aim of this study was to describe a new technique called the "happy protocol" for the treatment and prevention of the sad umbilicus. The periumbilical region is treated using a 980-nm diode laser set to an output power of 20 W, with a total delivered energy of 5000 J. The developed technique may be applied to correct shape distortions or to create a natural-looking and aesthetically pleasant umbilicus during liposuction. A decrease in the width of the umbilicus followed by an increase in height are observed in the first postoperative days. Patients who were followed up for 7 months postoperatively showed positive aesthetic results. The final outcome was an oval-shaped umbilicus, with increased height and reduced sagging in the periumbilical region.

Two- and Three-Segment Surgically Assisted Rapid Maxillary Expansion: A Clinical Trial.

BACKGROUND: The literature shows no consensus on whether two- or three-segment surgically assisted rapid maxillary expansion is the best operative technique. METHODS: The present clinical trial was designed to compare the outcome of two- and three-segment osteotomy surgically assisted rapid maxillary expansion. Thirty-two adult patients with transverse maxillary deficiency greater than or equal to 5 mm were randomly assigned to two- and three-segment groups (n = 16). Dimensional and psychological assessments (Oral Health Impact Profile and Brazilian Orthognathic Quality of Life Questionnaire) were carried out before surgical intervention and at one of the following time points: completion of expansion, removal of expanding device, 6 months after completion of expansion, or 10 months after completion of expansion. Dimensional assessments for asymmetric expansion of the maxilla and for changes in the area and volume of the palatine vault were performed on digital data from tomographic and laser scanning with the aid of an engineering inspection software. RESULTS: No statistically significant differences were found in asymmetry or stability outcomes between groups. The psychological benefit provided by the three-segment technique did not spread through the domains of the quality-of-life questionnaires. CONCLUSIONS: The current findings suggest that three-segment surgically assisted rapid maxillary expansion outcomes do not exceed those obtained with its two-segment counterpart regarding symmetry of maxillary expansion and stability of area and volume of the palatine vault. Furthermore, psychological nuances evidenced in two- and three-segment groups with the tools used play a limited, short-lasting role, or a specific, more sensitive assessment tool needs to be developed. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Skin field cancerisation: A systematic review of the literature regarding its treatment.

INTRODUCTION: Skin neoplasms are the most frequent malignant lesions, increasing patient's morbidity when associated with skin field cancerisation. There is a need to understand the current therapies, both clinical and surgical. METHODS: A systematic review was performed according to the PRISMA guideline, registered in PROSPERO: CRD42018114826, including studies from 2012 to 2019. RESULTS: Seven hundred and eighty-two studies were found, of which 21 were included. Of these, 8 primary studies were randomised controlled trials: fractional CO2 laser-assisted photodynamic therapy (PDT) vs. PDT (no significance), daylight PDT vs. PDT (no significance, daylight PDT had less adverse effects), trichloroacetic acid peel vs. 5-aminolaevulinic acid PDT (clinical improvement of aminolaevulinic acid PDT), 5-Fluorouracil 0.5%/Salicylic Acid 10% vs. vehicle (clinical improvement of 5-Fluorouracil 0.5%/Salicylic Acid 10%), photolyase vs. sun filters (no significance), sunscreens vs. sunscreens plus DNA repair enzymes (DNA Repair Enzymes was more effective in reducing field cancerisation). Only one systematic review was included in which there was effectiveness of daylight PDT in the treatment of actinic keratoses. The other 12 included studies had a lower level of evidence including surgical studies. CONCLUSION: Clinical studies are more relevant in the treatment of the field cancerisation. There is a lack of surgical studies.

Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial.

BACKGROUND: Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty. METHODS: The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted. RESULTS: There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003). CONCLUSION: The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Development and Validation of a Manual of Skin Care for Persons Deprived of Liberty in the São Paulo State Prison System: A Descriptive Study.

Brazil has the third largest prison population in the world. Studies on the health status of prisoners have shown that skin diseases, especially infectious skin diseases, are prevalent in this population. Because some skin diseases can be prevented, strategies to inform and guide incarcerated persons may be helpful. PURPOSE: The purpose of this study was to develop and validate a manual of skin care for use by prisoners in the São Paulo State Prison System. METHODS: To develop the manual, a Google search to ensure originality of the concept was conducted, followed by an integrative literature search of the MEDLINE and the Latin American and Caribbean Health Science Literature, and the medical records of the prison system were reviewed for content. The Delphi technique was used to validate content; the content validity index (CVI) was determined based on the ratings of an expert panel of 10 prison employees who were health professionals and have experience providing care to prisoners. Twenty (20) target-users (prisoners) also evaluated the manual. The experts responded to questionnaires (sent by email) containing 19 items related to the manual's objective, structure and presentation, and relevance. Items were rated on a Likert-type scale where 1 = inadequate, 2 = partially inadequate, 3 = adequate, 4 = very adequate, and NA = not applicable, and participants also could provide suggestions and comments on the manual. The prisoners used a paper-and-pencil questionnaire to assess the manual that included 14 items with 3-choice answers (agree, undecided, disagree) on the utility and ability to understand the manual topics and space to write concerns and suggestions regarding the utility of the content; they also could offer their thoughts and opinions about the manual. The proportion of agreement among responses was calculated. RESULTS: The overall CVI of the first round of evaluations was 1.0. Suggested changes were to include guidelines on the proper use of medications and modify some wording. The overall CVI of the next round was 1.0 (100% agreement). The evaluation by target users showed an agreement of 98.6%. The final version of the manual has 8 topics, 12 subtopics, and 29 illustrations; topics include skin, hair, and nail care and skin diseases. A printed version is available in the prison library and an electronic copy was sent to all prisons in the State of São Paulo to be printed as needed. CONCLUSION: A manual providing guidelines on skin care for prison populations was developed and validated with the intent to improve prisoner quality of life and care. Research to examine overall manual usage and the effect of the information and guidance on healthy behaviors, prevention, and management of skin diseases is warranted.

Mycophenolic Acid for Topical Immunosuppression in Vascularized Composite Allotransplantation: Optimizing Formulation and Preliminary Evaluation of Bioavailability and Pharmacokinetics.

Mycophenolic acid (MPA), is the active form of the ester prodrug mycophenolate mofetil (MMF). MMF is an FDA approved immunosuppressive drug that has been successfully used in systemic therapy in combination with other agents for the prevention of acute rejection (AR) following solid organ transplantation (SOT) as well as in vascularized composite allotransplantation (VCA). Systemic use of MMF is associated with gastrointestinal adverse effects. Topical delivery of the prodrug could thus provide graft-targeted immunosuppression while minimizing systemic drug exposure. Our goal was to develop a topical formulation of MPA with optimal in vitro/in vivo characteristics such as release, permeation, and tissue bioavailability to enable safety and efficacy evaluation in clinical VCA. Permeation studies were performed with a solution of MPA (10 mg/ml). In vitro release and permeation studies were performed for different semisolid formulations (Aladerm, Lipoderm, emollient, and VersaBase) of MPA (1% w/w) using a Franz Diffusion Cell System (FDCS). In vivo pharmacokinetic characterization of MPA release from Lipoderm was performed in rats. MPA in solution exhibited a steady state flux (3.8 ± 0.1 µg/cm2/h) and permeability (1.1 × 10-7 ± 3.2 × 10-9 cm/s). MPA in Lipoderm exhibited a steady state flux of 1.12 ± 0.24 µg/cm2/h, and permeability of 6.2 × 10-09 ± 1.3 × 10-9 cm/s across the biomimetic membrane. The cumulative release of MPA from Lipoderm, showed a linear single-phase profile with a R2 of 0.969. In vivo studies with MPA in Lipoderm showed markedly higher local tissue MPA levels and lower systemic MPA exposure as compared to values obtained after intravenous delivery of the same dose of drug (p < 0.05). We successfully developed for the first time, a topical formulation of MPA in Lipoderm with optimal in vitro/in vivo permeability characteristics and no undesirable local or systemic adverse effects in vivo. Our study provides key preliminary groundwork for translational efficacy studies of topical MPA in pre-clinical large animal VCA models and for effectiveness evaluation in patients receiving VCA.

Direct variable cost of the topical treatment of stages III and IV pressure injuries incurred in a public university hospital.

AIM: to estimate the direct variable costs of the topical treatment of stages III and IV pressure injuries of hospitalized patients in a public university hospital, and assess the correlation between these costs and hospitalization time. MATERIALS AND METHODS: Forty patients of both sexes who had been admitted to the São Paulo Hospital, São Paulo, SP, Brazil, from 2011 to 2012, with pressure injuries in the sacral, ischial or trochanteric region were included. The patients had a total of 57 pressure injuries in the selected regions, and the lesions were monitored daily until patient release, transfer or death. The quantities and types of materials, as well as the amount of professional labor time spent on each procedure and each patient were recorded. The unit costs of the materials and the hourly costs of the professional labor were obtained from the hospital's purchasing and human resources departments, respectively. Spearman's correlation coefficient and the Mann-Whitney and Kruskal-Wallis tests were used for the statistical analyses. RESULTS: The mean topical treatment costs for stages III and IV PIs were significantly different (US$ 854.82 versus US$ 1785.35; p = 0.004). The mean topical treatment cost of stages III and IV pressure injuries per patient was US$ 1426.37. The mean daily topical treatment cost per patient was US$ 40.83. There was a significant correlation between hospitalization time and the total costs of labor and materials (p < 0.05). There was no significant difference between hospitalization time periods for stages III and IV pressure injuries (40.80 days and 45.01 days, respectively; p = 0.834). CONCLUSION: The mean direct variable cost of the topical treatment for stages III and IV pressure injuries per patient in this public university hospital was US$ 1426.37.

High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture.

OBJECTIVE: To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. METHOD: Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. RESULTS: No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. CONCLUSION: High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

High voltage pulsed current in collagen realignment, synthesis, and angiogenesis after Achilles tendon partial rupture

ABSTRACT Objective To verify the efficacy of high voltage pulsed current in collagen realignment and synthesis and in angiogenesis after the partial rupturing of the Achilles tendon in rats. Method Forty male Wistar rats were randomized into four groups of 10 animals each: sham, cathodic stimulation, anodic stimulation, and alternating stimulation. Their Achilles tendons were submitted to direct trauma by a free-falling metal bar. Then, the treatment was administered for six consecutive days after the injury. In the simulation group, the electrodes were positioned on the animal, but the device remained off for 30 minutes. The other groups used a frequency of 120 pps, sensory threshold, and the corresponding polarity. On the seventh day, the tendons were removed and sent for histological slide preparation for birefringence and Picrosirius Red analysis and for blood vessel quantification. Results No significant difference was observed among the groups regarding collagen realignment (types I or III collagen) or quantity of blood vessels. Conclusion High voltage pulsed current for six consecutive days was not effective in collagen realignment, synthesis, or angiogenesis after the partial rupturing of the Achilles tendon in rats.

Effect of High- and Low-Frequency Transcutaneous Electrical Nerve Stimulation on Angiogenesis and Myofibroblast Proliferation in Acute Excisional Wounds in Rat Skin.

OBJECTIVE: This study evaluated the effects of high- (HF) and low-frequency (LF) transcutaneous electrical nerve stimulation on angiogenesis and myofibroblast proliferation in acute excisional wounds in rat skin. DESIGN: This was an experimental controlled and randomized study. PARTICIPANTS: An excisional wound was made on the back of 90 adult male EPM1-Wistar rats using an 8-mm punch. INTERVENTIONS: The animals were randomly assigned to the HF group (80 Hz), LF group (5 Hz), or control group. Transcutaneous electrical nerve stimulation (pulse duration, 200 microseconds; current amplitude, 15 mA) was delivered (session length, 60 minutes) on 3 consecutive days. MEAN OUTCOME MEASURE: Immunohistochemistry was performed on postoperative days 3, 7, and 14 for counting blood vessels and myofibroblasts. MEAN OUTCOME RESULTS: The LF group had significantly more blood vessels than the HF group on day 3 (P = .004). The HF group had significantly less blood vessels than did the control group on days 7 (P = .002) and 14 (P = .034) and less myofibroblasts than did both the LF and control groups on day 3 (P = .004) and less than did the control group on day 7 (P = .001). CONCLUSION: There seems to be a benefit to the use of LF transcutaneous electrical nerve stimulation in the healing of acute excisional wounds, but further studies are warranted.

Effects of Lidocaine, Bupivacaine, and Ropivacaine on Calcitonin Gene-Related Peptide and Substance P Levels in the Incised Rat Skin.

OBJECTIVE: To evaluate the effect of 2% lidocaine, 0.5% bupivacaine, and 0.75% ropivacaine on the release of substance P (SP) and calcitonin gene-related peptide (CGRP) in skin wounds. DESIGN: A primary, experimental, analytical, prospective, self-controlled, blinded study. SETTING: The study is set in a university research center. INTERVENTIONS: Twenty-eight Wistar rats were randomly divided into 4 groups: lidocaine, bupivacaine, ropivacaine, and the control. After general anesthesia, a local anesthetic or 0.9% saline (control) was injected subdermally along a 2-cm line on the dorsal midline of each rat; 30 minutes later, an incision (nociceptive stimulus) was made along this line. The animals were euthanized, and skin samples were collected from the center of the incision line and sent for CGRP and SP quantification. MAIN OUTCOME MEASURES: Quantification of CGRP and SP by Western blotting. RESULTS: Substance P levels were similar in the lidocaine and ropivacaine groups but were significantly lower than those of the control group (P = .002); no significant difference in SP levels was found between the bupivacaine and control groups. Procalcitonin gene-related peptide levels were significantly lower in the experimental groups than those in control subjects (P = .009), with no significant differences among the experimental groups. No significant differences in CGRP levels were found among all groups. Lidocaine and ropivacaine inhibited SP release. All 3 local anesthetics inhibited the release of procalcitonin gene-related peptide, but not the release of CGRP in rat skin. CONCLUSIONS: Lidocaine and ropivacaine may inhibit neurogenic inflammation by biochemical pathways activated by SP, whereas bupivacaine seems to have no influence on this process.

Sexual Function and Depression Outcomes Among Breast Hypertrophy Patients Undergoing Reduction Mammaplasty: A Randomized Controlled Trial.

PURPOSE: The breasts are important symbols of femininity and sensuality. Alterations such as breast hypertrophy can affect several aspects of women's quality of life. Breast hypertrophy is a prevalent health condition, which is treated by reduction mammaplasty. The aim of the present study was to assess sexual function and depression outcomes among breast hypertrophy patients undergoing reduction mammaplasty. METHODS: Sixty breast hypertrophy patients were randomly allocated to a control group (CG) (n = 30) or a breast reduction group (BRG) (n = 30). The patients in the CG were assessed at the first appointment as well as 3 and 6 months later. The patients in the BRG were assessed preoperatively as well as 3 and 6 months postoperatively. Validated instruments, the Female Sexual Function Index and the Beck Depression Inventory, were used to assess sexual function and depression among the subjects. The results of these assessments were compared within and between groups. RESULTS: Twenty-seven and 29 patients in the CG and the BRG, respectively, completed the 6-month follow-up period. At baseline, the groups did not differ significantly with regard to the main demographic data. In the initial assessment, the groups did not differ significantly with regard to Female Sexual Function Index or Beck Depression Inventory scores. Compared with the CG, the BRG reported better sexual function 3 (P = 0.015) and 6 (P = 0.009) months postoperatively. Regarding depression scores, the reduction mammaplasty group had better results 6 months postoperatively (P = 0.014). CONCLUSIONS: Reduction mammaplasty positively affected sexual function and depression levels in breast hypertrophy patients.

Can transcutaneous electrical nerve stimulation improve achilles tendon healing in rats?

BACKGROUND: Tendon injury is one of the most frequent injuries in sports activities. TENS is a physical agent used in the treatment of pain but its influence on the tendon's healing process is unclear. OBJECTIVE: To evaluate the influence of TENS on the healing of partial rupture of the Achilles tendon in rats. METHOD: Sixty Wistar rats were submitted to a partial rupture of the Achilles tendon by direct trauma and randomized into six groups (TENS or Sham stimulation) and the time of evaluation (7, 14, and 21 days post-injury). Burst TENS was applied for 30 minutes, 6 days, 100 Hz frequency, 2 Hz burst frequency, 200 µs pulse duration, and 300 ms pulse train duration. Microscopic analyses were performed to quantify the blood vessels and mast cells, birefringence to quantify collagen fiber alignment, and immunohistochemistry to quantify types I and III collagen fibers. RESULTS: A significant interaction was observed for collagen type I (p=0.020) where the TENS group presented lower percentage in 14 days after the lesion (p=0.33). The main group effect showed that the TENS group presented worse collagen fiber alignment (p=0.001) and lower percentage of collagen III (p=0.001) and the main time effect (p=0.001) showed decreased percentage of collagen III at 7 days (p=0.001) and 14 days (p=0.001) after lesion when compared to 21 days. CONCLUSIONS: Burst TENS inhibited collagen I and III production and impaired its alignment during healing of partial rupture of the Achilles tendon in rats.

Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation.

OBJECTIVE: To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS). METHODS: Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE]). RESULTS: Total Cronbach's alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms. CONCLUSION: The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

Can transcutaneous electrical nerve stimulation improve achilles tendon healing in rats?

BACKGROUND: Tendon injury is one of the most frequent injuries in sports activities. TENS is a physical agent used in the treatment of pain but its influence on the tendon's healing process is unclear. OBJECTIVE: To evaluate the influence of TENS on the healing of partial rupture of the Achilles tendon in rats. METHOD: Sixty Wistar rats were submitted to a partial rupture of the Achilles tendon by direct trauma and randomized into six groups (TENS or Sham stimulation) and the time of evaluation (7, 14, and 21 days post-injury). Burst TENS was applied for 30 minutes, 6 days, 100 Hz frequency, 2 Hz burst frequency, 200 µs pulse duration, and 300 ms pulse train duration. Microscopic analyses were performed to quantify the blood vessels and mast cells, birefringence to quantify collagen fiber alignment, and immunohistochemistry to quantify types I and III collagen fibers. RESULTS: A significant interaction was observed for collagen type I (p=0.020) where the TENS group presented lower percentage in 14 days after the lesion (p=0.33). The main group effect showed that the TENS group presented worse collagen fiber alignment (p=0.001) and lower percentage of collagen III (p=0.001) and the main time effect (p=0.001) showed decreased percentage of collagen III at 7 days (p=0.001) and 14 days (p=0.001) after lesion when compared to 21 days. CONCLUSIONS: Burst TENS inhibited collagen I and III production and impaired its alignment during healing of partial rupture of the Achilles tendon in rats.

Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS): Brazilian Portuguese translation, cultural adaptation and validation

Objective: To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS). Methods: Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE]). Results: Total Cronbach’s alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms. Conclusion: The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

Sensitivity of the Nipple-Areola Complex and Sexual Function Following Reduction Mammaplasty.

BACKGROUND: The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality. OBJECTIVE: To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction. METHODS: The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction. RESULTS: Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups. CONCLUSIONS: Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function.