Consideraciones acerca de la cirugía plástica en Santiago de Cuba / Considerations on plastic surgery in Santiago de Cuba

El problema de la conformidad del ser humano con las características específicas de su cuerpo puede tener su origen en un problema estético o en un aspecto de carácter puramente físico que limita de manera marcada el desarrollo de sus actividades diarias. Ambos pueden tener solución mediante una cirugía, especialmente la estética. El objetivo de este trabajo es reafirmar que la cirugía plástica estética resuelve verdaderos problemas de salud tanto física como mental al reconocer la labor de los especialistas de cirugía plástica como evaluadores y consejeros de pacientes que acuden a consulta en busca de ayuda en nuestra provincia. Se revisó la literatura nacional e internacional sobre el tema y se concluyó que la cirugía plástica con fines estéticos constituye una solución, al satisfacer las expectativas tanto de las personas que reciben el tratamiento, como de los especialistas que realizan el trabajo.

The problem of dissagrement of the human being with the specific characteristics of his body may have its origin in an esthetical problem or in a purely physical character affair which limits, in a marked way, the development of his daily activities. Both may be solved through a surgery, specially, a esthetic surgery. The objective of this work is to reaffirm that the plastic esthetic surgery solves real physical or mental health problems, so as to recognize the work of plastic surgery specialists as evaluators and advisers of patients visiting the provincial department who look for help. National and international literature on the topic was reviewed and it was concluded that plastic surgery with esthetic aims is a solution, as it satisfies the expectatives either from people searching treatment, as from the specialists who give the service.

The Evolution of Breast Reduction Publications: A Bibliometric Analysis.

OBJECTIVE: This study aims to make a bibliometric analysis of the studies on breast reduction (BR) between the years 1980 and 2016 and identify important studies through trend topics as well as active authors, countries, universities, scientific journals, and citation and co-citation analyses about BR. BACKGROUND: Although BR looks like one of the cosmetic surgeries performed in order to restore the woman's appearance, in fact it is a reconstructive surgery that eliminates back pain, stance disorder, headache, shoulder pain, back and cervical disk hernia, difficulty in breathing, hollowness caused by bra straps, hygiene problems under breasts (e.g., rash or fungal infections), and limitations in some daily activities. However, the related literature has little information about the publications on this issue. METHODS: Bibliometric analysis was performed by downloading all the documents published between 1980 and 2016 from Thomson Reuters Web of Science (WoS; Thomson Reuters, New York, NY, USA), using the keywords including "breast reduction", "gigantomastia", "reduction mammaplasty", and "reduction mammoplasty". RESULTS: There was a total of 1427 publications in the WoS database. Of these publications, 869 (60.90%) were research articles. The top three research areas of these publications were surgery with 1178 (82.55%) publications, oncology with 78 (5.47%) publications, and obstetrics gynecology with 67 (4.70%) publications. The top three countries that contributed to the literature most were the USA (515), England (147), and Turkey (83), respectively; the top university that contributed most was Harvard University, and the top two authors who contributed most were Drew PJ and Iwuagwu OC (13; 0.91%). The top-cited publication was "A Simplified Vertical Reduction Mammaplasty: Shortening the Learning Curve" written by Hall-Findlay, EJ in 1999. The journals with top numbers of publications were Plastic and Reconstructive Surgery (483; 33.85%), Annals of Plastic Surgery (164; 11.50%) and Aesthetic Plastic Surgery (147; 10.30%) respectively. CONCLUSION: Despite the fact that the BR literature is contributed by developed countries, developing countries, particularly Turkey and Brazil, also had significant contributions to the literature. LEVEL OF EVIDENCE V: 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 .

Mamoplastias redutoras e mastopexias realizadas no HC-UNICAMP: análise comparativa entre duas técnicas / Reduction mammoplasties and mastopexies performed at HC-UNICAMP: comparative analysis between two techniques

Introdução: Diferentes técnicas para mamoplastia redutora e mastopexia são descritas na literatura, visando a resultados que reconstituam o polo superior, ofereçam melhor projeção e proporcionem tratamento adequado para a ptose mamária. No entanto, devemos nos atentar para a segurança da técnica, com manutenção da vascularização, inervação dos tecidos e possibilidade de amamentação. Análise comparativa com pacientes operadas pela técnica com retalho de pedículo inferior e pacientes operadas pela técnica com sutura circular em bolsa. Métodos: Análise de 85 pacientes submetidas à mamoplastia redutora ou mastopexia sem implantes, entre janeiro de 2011 e dezembro de 2012, no Hospital de Clínicas da Unicamp. Foram excluídos 31 pacientes, as quais foram submetidas apenas à mamoplastia redutora pela técnica de Pitanguy (sem utilização de retalhos ou sutura circular). Dentre as 54 pacientes restantes, cinco foram posteriormente excluídas devido ao não comparecimento à consulta ou à não realização da ultrassonografia pós-operatória. Foram agrupadas 16 pacientes submetidas à sutura circular contínua e 33 pacientes operadas pela técnica de pedículo inferior. Resultados: Dados demográficos foram semelhantes nos dois grupos. Maior número de pequenas complicações e resultados insatisfatórios foi observado no grupo submetido à técnica de pedículo inferior, bem como maior índice de achados ultrassonográficos relevantes no pós-operatório. Conclusão: A técnica de sutura circular contínua apresentou elevado índice de satisfação, menor número de complicações e resultados mais duradouros quando comparados com a técnica de pedículo inferior, durante o período analisado.

Introduction: Several reduction mammoplasty and mastopexy techniques are described in the literature, with the aim of reconstituting the upper pole, offering better projection, and providing adequate treatment for breast ptosis. However, particular attention should be devoted to the safety of the technique, with maintenance of vascularization, tissue innervation, and the capability of breastfeeding. Female patients operated on with the inferior pedicle flap technique were compared with those operated on with purse-string circular suturing. Methods: Eighty-five patients who had undergone reduction mammoplasty or mastopexy without implants, between January 2011 and December 2012 at Unicamp's Clinical Hospital, were evaluated. Thirty-one patients who only underwent reduction mammoplasty by Pitanguy's technique (without the use of flaps or circular sutures) were excluded. Of the remaining 54 patients, five were subsequently excluded for not attending medical appointments or failure to have postoperative ultrasonography. A group of 16 patients who had undergone circular suturing and a group of 33 operated on by the inferior pedicle technique were considered. Results: Demographic data were similar for both groups. A higher number of minor complications and unsatisfactory results were observed in the group that underwent the inferior pedicle technique, who also had a higher rate of relevant post-operative ultrasonography events. Conclusion: The circular suturing technique resulted in a high satisfaction rate, lower number of complications, and longer lasting results than the inferior pedicle technique, during the period analyzed in this study.

Mastoplastia redutora associada a implante de silicone: quando indico? / Reduction mastoplasty with silicone implants: When is it indicated?

Introdução: Insatisfação dos pacientes com resultado de mamoplastia redutora pode ser identificado em alguns casos, especialmente quando apresentam ptose acompanhada de flacidez excessive, estrias, e ainda, componente mamário mais gorduroso que glandular. Nesses tipos de pacientes, é muito difícil conseguir bons resultados por longo período. Implantes mamários de pequeno volume, podem ser colocados no mesmo tempo da mamoplastia redutora com o objetivo de se obter melhor forma, contorno e projeção das mamas, com maior satisfação a longo prazo. Método: No período de 1997 a 2012, duzentos e sessenta e quatro pacientes com idade entre 27e 55 anos (idade média de 38), foram submetidas à mamoplastia redutora com imediata colocação de implante mamário. Resultados: Foram obtidos resultados satisfatórios, com adequado preenchimento do pólo superior, mamas firmes e reduzida estatística de ptose pós-operatória. Foram identificados dois casos de carcinoma in sito, como achados no anátomo-patológico. Conclusão: Mastoplastia redutora associada a implantes de silicone é um procedimento seguro para casos selecionados.

INTRODUCTION: Patient dissatisfaction with reduction mammoplasty outcomes can occur, especially in cases of ptosis accompanied by excessive flaccidity, striations, and a higher fat than glandular content. In such cases, achieving long-lasting results is very difficult. Small-volume breast implants can be placed during the reduction mammoplasty with the purpose of obtaining better breast shape, contour, and projection as well as greater long-term satisfaction. METHOD: Between 1997 and 2012, 264 patients aged 27-55 years (mean, 38) underwent reduction mammoplasty with immediate placement of breast implants. RESULTS: Satisfactory results were obtained, with adequate filling of the upper pole, increased breast firmness, and statistical reduction in postoperative ptosis. Two cases of carcinoma in situ were identified in the pathological exam. CONCLUSION: Reduction mastoplasty associated with silicone implants is safe for selected cases.

Pioderma gangrenoso en mamoplastía de reducción con pedículo inferior / Pyoderma gangrenosum secondary to reduction mammoplasty

Background: Pyoderma gangrenosum (PG) is an uncommon inflammatory and ulcerative disorder of the skin. It may be associated with immune deficiencies. It is usually located in the extremities and its appearance after reduction mammoplasty is exceptional. We report three patients with the disease. A 54 years old female subjected to a bilateral reduction mammoplasty with an inferior pedicle. She developed a pyoderma gangrenosum and was treated with systemic steroids and local application of Dapsone with remission of lesions and healing after one month of evolution. A 23 years old women subjected to the same surgical procedure, which developed a wound dehiscence with ulcerative lesions, was treated with steroids and Azathioprine, reducing the local inflammation but leaving a severe esthetic sequel. A 21 years old woman subjected to the same surgical procedure, develop bilateral wound dehiscence and ulcerative lesions, she was treated with steroids and antimicrobials achieving a secondary healing...

Introducción: El Pioderma Gangrenoso es una enfermedad poco frecuente, de difícil diagnóstico y manejo. Puede estar asociado a otras enfermedades, en donde la alteración de la respuesta inmune es común. Su presentación por lo general corresponde a lesiones ulceradas de la piel ubicadas con frecuencia en las extremidades, siendo su presentación en las mamas excepcional; y mucho más rara su relación post mamoplastía de reducción. Métodos: Se realizó una revisión de pacientes sometidas a mamoplastía de reducción con pedículo inferior, asociadas al desarrollo de pioderma gangrenoso post-quirúrgico, durante un período comprendido entre los años 2000 y 2011. Resultados: Se recolectaron 3 pacientes, se describen sus casos clínicos con respecto a esta ubicación, analizando su presentación, evolución y manejo de la enfermedad. Discusión: La presentación del pioderma gangrenoso post-quirúrgico en relación a la mamoplastía de reducción comparte ciertas similitudes, las cuales deben orientar al diagnóstico precoz y de esta forma evitar manejos erróneos que pueden ser deletéreos, secuelantes e incluso potencialmente mortales...

Cirurgia de redução mamária e o mastologista / Breast reduction surgery and the breast surgeon

O tratamento cirúrgico de neoplasias mamárias benignas e malignas, assim como a abordagem de hipertrofias e assimetrias mamárias, requer do mastologista conhecimentos técnicos anteriormente utilizados apenas na área da cirurgia plástica. As técnicas de mamoplastia redutora utilizadas nos dias atuais derivam de técnicas descritas há muitos anos, com diferentes adaptações, objetivando sempre melhores resultados imediatos e tardios. As alterações estruturais e cicatriciais provocadas por esse tipo de cirurgia devem ser bem conhecidas e acompanhadas quando for empregada na solução de problemas oncológicos. Nesta breve revisão, discutem-se diversos aspectos técnicos e conceituais referentes à mamoplastia redutora com relevância na clínica mastológica atual.

New trends in breast cancer surgery motivated breast surgeons to get acquainted with surgical skills formerly only employed in aesthetic surgery. The modern surgical approach to reduction mammaplasty represents a surgical procedure improvement for better shape and reduced scars. Postsurgical changes, some of which may mimic cancer must be recognized and followed by mammography and clinical examination. In this review, we go through some issues about reduction mammaplasty and its importance for breast surgeons.

Biópsia do linfonodo sentinela em mulheres com câncer de mama e mamoplastia redutora prévia - técnica radioguiada / Sentinel lymph node biopsy in women with breast cancer after reduction mammoplasty - radiogueded technique

A mamoplastia redutora tem sido considerada uma contra-indicação relativa para a biópsia do linfonodo sentinela (LS), porque há possibilidade de que os vasos linfáticos tenham sido interrompidos pelo procedimento cirúrgico. Relatamos 13 mulheres com 14 carcinomas de mama detectados após cirurgia de redução das mamas e que se submeteram à biópsia do LS. As pacientes realizaram linfocintilografia detectou a presença de LS em 92,9% (13/14) dos casos e a taxa de sucesso da biópsia cirúrgica foi de 85,7% (12/14). Verificou-se doenças metastática para o LS em 33,3% (4/12) dos casos e realizou-se linfadenectomia axilar em três dessas quatro pacientes, constatando-se metástases adicionais em linfonodos não-sentinelas em um caso. Não se deve considerar a mamoplastia redutora prévia uma contra-indicação para a biópsia do LS.

Breast reduction surgery is considered a relative contraindication for sentinel node biopsy because the possibility that lymphatics have been interrupted by the procedure. We describe 13 patients with 14 carcinomas who underwent sentinel lymph node biopy after breast reduction surgery. The patients underwent presurgical lymphoscintigraphy and intraoperatively the sentinel lymph node was identified with a handheld gamma probe. Lymphoscintigraphy was successful in 92.9% (13/14) of the cases and sentinel lymph node biopsy was successful in 85.7% (12/14). Sentinel node metastases were found in 33.3% (4 / 12). Axillary dissection was performed in 3 of these patients, and additional metastases were found in one patient. Sentinel lymph node biopsy should not be considered a contraindication after breast reduction surgery.