Unusual findings on MRI of patients with breast implants Soares, Igor Moura; Cammarota, Marcela Caetano; Camelo, Rosimara Eva Ferreira Almeida ...
Revista Brasileira de cirurgia plástica,
06/2024, Letnik:
39, Številka:
2
Journal Article
Odprti dostop
Introduction: Breast prosthesis implantation is one of the most performed surgeries in the world. Over time, different materials were used to reconstitute breast volume. Despite technical and ...surgical improvements and the safety of current implants, patients are faced with potential “unusual” complications: intracapsular and extracapsular ruptures, late hematomas and contour deformity, intra-nodal silicone, or herniation of the fibrous capsule. Magnetic resonance imaging (MRI) is the most useful imaging modality for investigating these complications. Method: This is a series of cases in which so-called “unusual” changes were reported, due to their low frequency or lack of mention in the literature, after surgeries to include a silicone prosthesis. The data were collected from the personal experience of one of the authors in his private clinic, in the city of Brasília-DF, between April 2015 and March 2023. Results: A total of 211 patients were evaluated, and less frequent changes were found in the MRI of 12 patients (5.68%), of which: 5 with a large amount of pericapsular fluid, 3 with capsular granuloma, 1 late seroma with hemorrhagic content, 1 intra and extracapsular rupture, 1 nodule close to the implant’s fibrous capsule, 2 axillary lymph node disease ipsilateral, 1 intra-nodal silicone, 1 pectoral muscle edema, 2 desmoid tumor and 1 herniation of the fibrous capsule. Conclusion: It is estimated that there are 50 million women with breast implants in the world. Based on this data, the number of so-called “unusual” complications becomes a diagnostic challenge for the plastic surgeon and radiologist.
Introduction: Breast cancer has increased progressively in recent years, and with this, the need for diagnosis and earlier treatment has also increased. Currently, in Brazil, breast cancer accounts ...for 29.7% of cancer cases in women. The reconstruction of the nipple-areolar complex (NAC) has focused on greater attention due to the search for symmetry and naturalness, which is the final stage of this whole process. The objective is to evaluate the maintenance of the size, contour, color, symmetry and shape change of reconstructed NAC after mastectomies associated with radiotherapy. Methods: A retrospective study was conducted analyzing the evolution of reconstructed areolas after total mastectomy associated with adjuvant treatment with radiotherapy. Two groups were selected: group 1 (unilateral reconstruction) and group 2 (bilateral reconstruction). Comparisons were made between the reconstructed NAC areola, group 1, with that of the contralateral NAC and in group 2, between the two reconstructed areolas Results: After the inclusion of 56 patients in the study, 71 reconstructed areolar complexes were included. Symmetry was classified as good in 77.46% of all cases (p=0.706). Twenty-five reconstructions were performed in areas under the effect of radiotherapy, and only 9 cases showed decreased areola size (p=0.050), evolving with an asymmetry in 8 cases, 4 in the radiotherapy region (p=0.706). The areolar contour showed a similarity between cases treated with radiotherapy and untreated (p=0.918). Conclusion: Adjuvant radiotherapy was a predisposing factor for changes that may arise during the postoperative period of reconstruction of the nipple-areolar complex, according to statistical analysis.
Introduction: The treatment of breast cancer includes not only curative therapies but also breast reconstruction. Radiotherapy, an adjuvant strategy, provides favorable outcomes by reducing the rate ...of recurrence of the disease. This study aimed to compare histological differences between irradiated and non-irradiated breasts in the same patient. Methods: This is a prospective cohort study of patients undergoing breast reconstruction with prosthesis or expander under pectoralis major muscle flap that compared histological skin patterns, subcutaneous cell tissue, pectoralis major muscle, and implant capsule of irradiated and non-irradiated breasts in paired samples of the same patient. All patients included in this study were irradiated in only one breast. The results of the anatomopathological analysis were compared to clinical findings and intraoperative macroscopic aspects. Results: The study included a total of 7 patients with a mean age of 52.15 years. The main histological findings in the skin and subcutaneous cellular tissue of the irradiated breast were as follows: epidermal hyperplasia, flattening of the papillary layer, atrophy of the skin appendages, vascular congestion in fatty tissue, high density of skin collagen fibers, hyalinization, and reduction of elastic fibers in the deep dermis and unidirectional alignment of collagen fibers. The main histological findings for the capsule and pectoralis major muscle in the irradiated breast were as follows: lower density of elastic fibrosis, perivascular fibrosis, synovial metaplasia, skeletal muscle sequestration at the interface with the capsule, capsular hyalinization, and capsular fribrosclerosis. Conclusion: We found common histological changes in irradiated breasts in most patients. These findings are compatible with the clinical and macroscopic changes observed. This study presents itself as a pilot for the development of further studies investigating the physiopathological mechanisms of the described histological changes.
Triangular flap for nipple reconstruction Cammarota, Marcela Caetano; Galdino, Milena Carvalho Almeida; Daher, Leonardo Martins Costa ...
Revista Brasileira de cirurgia plástica,
03/2020, Letnik:
35, Številka:
1
Journal Article
Odprti dostop
Introduction: Despite the many published techniques, there are difficulties in satisfactorily achieving a nipple areola complex (NAC) with long-lasting results. The objective is to demonstrate ...results using the triangular cutaneous flap technique in nipple reconstructions and compare it with previously published techniques. Methods: A prospective study of nipple reconstruction using the triangular cutaneous flap technique from January 1, 2015, to March 1, 2016. Surgical technique: Marking of an equilateral triangle; decortication of the three points of the triangle that are united in the form of an envelope, with the central area adhered to the neo-breast; total skin grafting for construction of the areola. The patients were evaluated and results classified as fully satisfactory, satisfactory, partially satisfactory, or unsatisfactory. Primary type of breast reconstruction, postoperative or neoadjuvant chemo- or radiotherapy complications, comorbidities, and postoperative complications were evaluated. Statistical evaluation was performed using Fisher's exact test, chi-square test, and post hoc analysis (significance p < 0.05). Results: Thirty-one patients underwent nipple reconstruction using the triangular cutaneous flap technique, 17 unilateral and 14 bilateral, totaling 45 reconstructions. Mean age was 50 years, mean body mass index was 24.95 kg/m2, and mean follow-up period was 14 months. Rated: demographic data, complications of patients versus the type of primary breast reconstruction and completion of chemo- and/or radiotherapy, types of breast reconstruction performed, evaluation of the nipples versus reconstruction, evaluation of the nipple reconstruction technique versus satisfaction of evaluators, and nipple complications versus reconstruction technique. Conclusion: The original triangular cutaneous flap technique presents the advantages of easy execution and safety in reconstruction of the NAC.
Introduction: The benefits of immediate reconstruction have been increasingly documented in the literature over the past few years. Today, with some exceptions, immediate reconstruction is the ...preferred surgical choice for breast cancer patients. In the recent years, the number of reconstructions using expanders and implants has increased. Methods: This retrospective study conducted between 2013 and 2014 included patients undergoing mastectomy followed by breast reconstruction, who were divided into direct implant reconstruction and expander treatment groups. Several variables were evaluated. Results: A total of 138 reconstructions (57 implants and 81 expander-implant) were performed. There were no intergroup differences in postoperative complications. Radiotherapy did not influence complications. Implant reconstruction patients underwent fewer surgeries (1.78 vs 2.54) and had fewer postoperative returns (8 vs 11.75). Conclusion: Immediate implant and expander-implant reconstruction approaches present low and similar postoperative complication rates. Patients undergoing implant reconstruction had a lower return rate and underwent fewer surgeries than those undergoing expander-implant reconstruction.
Post-Bariatric surgery: six surgeries in two steps DAHER, JOSÉ CARLOS; CAMPOS, AMANDA COSTA; CAMMAROTA, MARCELA CAETANO ...
Revista Brasileira de cirurgia plástica,
06/2019, Letnik:
34, Številka:
2
Journal Article
Odprti dostop
Introduction: Weight reduction achieved after bariatric surgery can result in deformities of various parts of the body. The need for reduction of leftover skin and body remodeling makes patients seek ...body contouring surgery to improve their quality of life. The aim of the study was to present a protocol for post-bariatric plastic surgery at Daher Hospital. Methods: This was a retrospective longitudinal observational study. As routine protocol, we divided the procedures into two steps, performed in different surgical stages, which we termed the two-level principle. Herein we describe the routine of pre, intra, and postoperative care, as well as details of the surgical techniques. Photographic images were analyzed by an external evaluator. Results: The study included 13 ex-obese patients, with a mean age of 44 years. Of them, 6 patients underwent lower- and upper-level surgeries and another 6 underwent lower-level surgeries. The mean surgical time for the lower level was 4 hours and 54 minutes and that for the upper level was 4 hours and 5 minutes. A total of 92.30% of the patients were satisfied with the results. An external evaluator classified 92.30% of the cases as good or great. Conclusion: Circumferential abdominoplasty has immense benefits and complementary surgeries are vital for a satisfactory result. Reduction of the surgical time requires great synchronization of the surgical team, which allows procedures to be performed simultaneously by multiple surgical teams working in different body parts. Satisfactory results and low complication rates allow the applicability of our routine in post-bariatric patients.
Introduction: Due to the increased incidence of breast cancer, the demand for breast reconstruction has been increasing, along with concerns regarding the satisfaction and quality of life of the ...patients. Mastectomy can be a traumatic experience, especially when it is perceived as a mutilation, which can impact self-esteem and emotional stability. The BREAST-Q® questionnaire was internationally validated and formulated for the pre- and postoperative assessment of quality of life related to breast reconstruction. This study aimed to evaluate quality of life and aesthetic result satisfaction in patients who underwent breast reconstruction with implants by comparing the period after breast reconstruction with the period before. Method: A retrospective longitudinal observational study was carried out by reviewing the charts of patients who underwent breast reconstruction using silicone or tissue expander implants from January 2014 to December 2016, in association with a cross-sectional study of the Breast-Q® questionnaire and an evaluation of aesthetic results based on photographic analysis before and after surgery. Results: We selected 74 patients who underwent breast reconstruction with implants (79.7% with silicone prostheses and 20.3% with expanders); 95.94% of the reconstructions were immediate, and no particular laterality predominated. We obtained statistical significance in the domains of both breast satisfaction and physical well-being. Most cases were considered satisfactory by the external evaluator. Conclusion: The patients' quality of life in the period after breast reconstruction with breast implants was superior to that in the period prior to the procedure.
Introduction: Radiation negatively influences the results of breast reconstruction using implants. However, the effects of radiation on breast reconstruction with autologous tissue is still unclear. ...The objective of this study was to evaluate the postoperative complications in patients who underwent immediate and late breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap and statistically correlate these complications with the use of radiotherapy (RT). Methods: A retrospective survey of the medical records of patients who underwent breast reconstruction was conducted. Of the patients, 126 underwent breast reconstruction with a TRAM flap between 2004 and 2011. The presence or absence of RT and postoperative complications in the immediate and late reconstructions was assessed. The patients were divided into 3 groups as follows: 1) without RT (TRAM alone group), 2) TRAMRT group, and 3) RTTRAM group. The patients in each group were evaluated for the presence and absence of minor and major complications, and results were statistically analyzed. Results: The groups were considered homogenous for age and body mass index. The incidence of major complications was higher in the groups with RT after TRAM (29.6%) than in the other groups, namely the groups without RT (23.4%) and with RT before TRAM flap reconstruction (5.6%). However, the differences among the groups were not statistically significant. No evidence of statistically significant differences in minor complications were found among the groups. Conclusion: In this study, adjuvant RT was not a potentiating factor of complications in the patients who underwent immediate reconstruction with a TRAM flap after mastectomy.
INTRODUCTION: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. METHODS: A retrospective records review of patients who ...underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. RESULTS: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. CONCLUSIONS: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used.
INTRODUCTION: The abdomen is an important aesthetic functional segment in the characterization of the body contour. In abdominoplasty, the placement and shape of the umbilical scar are important for ...a satisfactory result. This study aimed to describe the technique of vertical omphaloplasty and to present the results obtained. METHODS: Retrospective longitudinal descriptive study composed of patients who underwent vertical omphaloplasty during classic abdominoplasty between 2014 and 2017. The technique consists of a vertical transcutaneous incision without removal of the skin spindle and with minimal degreasing of the wall around the umbilicus, followed by the transfixing a point in the lateral portion of the umbilical pedicle, allowing its invagination and fixation close to the aponeurosis of the rectus abdominis. RESULTS: In the 128 patients evaluated, the patients' age ranged from 25 to 62 years, with a mean of 32 years. The mean time of surgery was 2 h and 33 min. No surgical complications occurred, such as hematoma or abdominal flap necrosis. Two cases of dehiscence, four cases of hypertrophic scar, two cases of stenosis, and one case of umbilical necrosis were observed. In outpatient follow-up, 92.2% of the patients were very satisfied with the final result. The technical analysis presented an 88% degree of satisfaction. CONCLUSION: The technique described presents satisfactory results, reduces the possibility of the appearance of a cicatricial ring, and allows minimizing one of the stigmas of abdominoplasty, which is a very visible umbilical scar.
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