Reconstrucción mamaria en el Hospital S. Juan de Dios de Costa Rica: un estudio transversal / Mammary reconstruction at the S. Juan de Dios Hospital, Costa Rica: a transversal study

RESUMEN

La cirugía reconstructiva de mama fue introducida en el Hospital San Juan de Dios a partir de los años 80 por su demostrada mejoría en la calidad de vida de la paciente mastectomizada . Actualmente se realizan dos procedimientos quirúrgicos el colgajo del músculo recto abdominal (TRAM) y el colgajo del músculo dorsal ancho (DA). Planteamos un estudio transversal para describir la experiencia del Hospital San Juan de Dios en relación a los dos procedimientos quirúrgicos principales para la reconstrucción mamaria. Se obtuvo una muestra de110 expedientes clínicos con un error estándar del 5% y una significancia del 97%. Se tomaron en cuenta las variables edad, complicaciones, estancia hospitalaria, decisión de reconstrucción areola pezón y simetrización mamaria. La edad promedio de las pacientes fue de 49.2 años con una desviación estándar de 8.8 años. A las complicaciones y la técnica quirúrgica seles realizó la prueba de (..) (AU)

ABSTRACT

Mammary Reconstruction was introduced in the Hospital San Juan de Dios in the 80’s for the demonstrated improvement in the quality of life of the mastectomized patient; by the moment we practise two surgical procedures the Transversal Rectums Abdominal Muscle flap (TRAM) and the Dorsal muscle flap (DA). We made a traversal study to describe the experience of the Hospital San Juan de Dios in relation to this two main surgical procedures for mammary reconstruction. A sample of 110 clinical files was obtained with a standar error of the 5 % and a significance of 97%. We study variables such as age, complications, hospital stay and decision of symmetrical reconstruction of areola nipple and contralateral breast mammary. The average age of the patients was 49.2 years with a 8.8 year-old standard deviation. Complications and the surgical technique was carried out test of 2 lines (squared Chi) which was significant (p=0.003), therefore we discarded dependence between complications and surgical procedure. Hospital stay seems to be associated to surgery . The areola-nipple reconstruction and surgery for contralateral breast symmetry present a low frequency among the patients. The average age of the patients coincides with those described in other studies and with the age in that the appearance of mammary cancer is more frequent. There is not dependence between surgery type and the evaluated complications; nevertheless it is considered there are inherent complications to each technique. The low acceptance of surgery to get symmetry and reconstruction of the complex areola - nipple may be depends on these patients have sufered multiple surgeries and adjuvant treatments, so they are a little reluctant to other additional surgical procedures. The hospital stay can be associated to the surgical technique, since TRAM technique needs bigger cares than the DA one. As conclusion, TRAM and DA are two appropriate surgical options for mammary reconstruction; the election will depends on the patient’s characteristics and on the surgeon’s dealer. However in those patients who are candidate to both surgeries, TRAM should be the like first surgical election (AU)