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INTRODUCTION: Measuring breast volume is important to obtain satisfactory breast surgery results, and many techniques are used for this purpose. Thus, the aim of the present study was to compare 3 breast volume techniques: Pessoa's single marking technique, magnetic resonance imaging (MRI) and Crisalix 3D software®. METHODS: Fourteen patients indicated for mammoplasty were selected. Three breast volume measurement techniques were compared: Pessoa's single marking technique, MRI and Crisalix 3D software®. The volumes were tabulated and analyzed using R software. RESULTS: Average age was 30.93 ± 10.25 years. The breast volume was 1554.54 ± 512.54 cm3, as measured by the MRI technique (considered the gold standard), 1199.64 ± 403.13 cm3 using Crisalix 3D software® and 1518.04 ± 468.72 cm3 by Pessoa's single marking technique. Comparison between the Crisalix 3D software® and MRI techniques using the pairwise t test demonstrated a statistically significant difference (t = 4.3957, df = 27, p value = 0001543), but no significant difference between the single marking and MRI techniques (t = 1.3841, df = 27, p value = 0.1777). CONCLUSION: When compared to MRI, breast volume measurement using Pessoa's single marking technique showed no statistically significant difference between them. However, the Crisalix 3D® technique exhibited a difference in relation to MRI. Anthropometric measurements are useful in measuring breast volume because they are easy to obtain, practical and inexpensive, and should be part of a plastic surgeon's arsenal. LEVEL OF EVIDENCE IV: 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 .

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BACKGROUND: Since 1985, the author has been using the single central block technique for breast reduction and mastopexy, prioritizing the good relation between the final breast shape and the length of the scars, different from other authors who emphasize only the shape of the breast (Peixoto in Plast Reconstr Surg 65(2):217-225, 1980; Aesthet Plast Surg 8:231-236, 1984) and others who have drawn attention to the length of the scars (Arié in Rev Latinoam Cir Plast 3:23-31, 1957; Bozola in Plast Reconstr Surg 85:728-738, 1990; Sepúlveda in Rev Bras Cir 71(1):11-18, 1981). In this study, the author describes the use of a single central block of the mammary tissue and the nipple-areolar complex (NAC), dissected from the skin flaps and based on the superior vascular pedicle for reduction mammoplasty and mastopexy (Erfon et al. in Annals of the international symposium recent advances in plastic surgery, São Paulo, 1989; Hinderer (ed) Plastic surgery, Elsevier, Madrid, 1992; Proceedings of the 65th annual scientific meeting of the American society of plastic and reconstructive surgeons, Dallas, 1996). METHODS: A retrospective study was performed, evaluating patients who underwent breast reduction and mastopexy using the single central block technique from July 1985 to December 2018 by a senior author. RESULTS: A total of 2097 procedures were performed using this technique, 1556 being reduction mammoplasties and 541 mastopexies. The mean patient age was 44, and the mean weight of tissue resected was 455 g. Fat necrosis on the distal area of the flap was observed in 47 cases (2.24%). Hematoma was observed in 6 patients (0.28%). Surgical revisions were undertaken in 75 patients (3.57%). Hypertrophic scars occurred in 12 of the cases (0.57%). Dehiscence in the inverted "T" scars occurred in 78 of the surgeries (3.71%). CONCLUSIONS: This technique allows the surgeon to easily form a good cone shape of the breast, repositioning the NAC and preserving its vascularization and sensation without tension on the skin flaps sutures, resulting in smaller and better scars. LEVEL OF EVIDENCE IV: 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.

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Introdução: A mamoplastia redutora é ainda um procedimento que desafia o cirurgião plástico. O objetivo é demonstrar os resultados no tratamento de variados graus de hipertrofia e ptose mamária utilizando-se a técnica de Marcação Única, proposta por Pessoa, durante o treinamento de novos cirurgiões plásticos. Métodos: Coorte retrospectivo de 95 pacientes submetidas à mamoplastia redutora pela técnica de Pessoa. Incluídas pacientes com ptose, hipertrofia, gigantomastia e/ou assimetria das mamas. Os procedimentos foram realizados por residentes do primeiro, segundo e terceiro ano. Como fatores de exclusão foram usados: distúrbios psicológicos, obesidade mórbida e/ou pacientes com indicação de implante de prótese sem redução de pele e/ou aréola. Foram avaliados a idade, sexo, volume resultante, grau de satisfação, complicações e dificuldades dos residentes para realização do procedimento cirúrgico. Resultados: Todas as pacientes do sexo feminino, com idade entre 21 e 61 anos. 90,53% das pacientes declararam-se muito satisfeitas, 5,26% satisfeitas, 3,16% pouco satisfeitas e 1,05% insatisfeita. Como complicações, foram observadas necrose de complexo areolopapilar (1,05%), epidermólise (11,58%) e deiscência de sutura (9,47%). As dificuldades encontradas pelos residentes, dependendo da etapa do procedimento cirúrgico, variaram entre 11,1% e 55,6%. Conclusões: Verificou-se alto grau de satisfação tanto da parte das pacientes quanto dos residentes envolvidos. Os resultados encontrados confirmam a efetividade da técnica no treinamento de residentes.

Introduction: Reduction mastoplasty is still a challenging procedure for plastic surgeons. The Objective is to show the results of the treatment of different degrees of breast hypertrophy using Pessoa's single marking technique performed while training plastic surgeons. Methods: A retrospective cohort of 95 patients underwent reduction mastoplasty using Pessoa's technique. The cohort included patients with breast ptosis, hypertrophy, gigantomastia, and/ or breast asymmetry. The procedures were performed by first-, second-, and third-year residents. The exclusion criteria were psychological disorders, morbid obesity, and/or indication for prosthesis implantation without skin and/or areola reduction. The analyzed factors were age, sex, final size, patient's degree of satisfaction, complications, and difficulties experienced by the residents in performing the surgery. Results: All patients were women aged between 21 and 61 years. Of the patients, 90.53% reported being very satisfied; 5.26%, satisfied; 3.16%, poorly satisfied; and 1.05%, dissatisfied. The complications observed were necrosis of the nipple-areola complex (1.05%), epidermolysis (11.58%), and suture dehiscence (9.47%). The rate of difficulty experienced by the residents varied between 11.1% and 55.6%, depending on the step of the surgical procedure. Conclusions: A high degree of satisfaction was reported by both the patients and residents. The results confirm the effectiveness of the technique while training residents.

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Introdução: Mesmo com os avanços das cirurgias conservadoras, a mastectomia ainda é uma cirurgia bastante realizada. Todavia, muitas pacientes não conseguem submeter-se à reconstrução imediata, passando a integrar uma crescente fila à espera da cirurgia reparadora. Com o intuito de diminuir tal demanda, foram criados os programas de mutirão cirúrgicos. O objetivo deste trabalho é analisar os resultados referentes ao 2º Mutirão Nacional de Reconstrução Mamária (MNRC), realizado no Serviço de Cirurgia Plástica do Hospital Universitário Walter Cantídio (SCPMR-HUWC). Método: Estudo de coorte prospectiva, no qual foram avaliadas as 16 pacientes submetidas à reconstrução mamária no 2º MNRM no SCPMR-HUWC. As pacientes foram acompanhadas pelo período de 6 meses e os dados obtidos foram tabelados e analisados. Resultados: 16 pacientes, todas mulheres, foram submetidas à reconstrução mamária pós-mastectomia. A idade variou entre 39 e 72 anos, com média de 49 anos. Dentre as complicações precoces, foram observados seroma em região dorsal (13%), necrose parcial da pele da mastectomia (6%), deiscência parcial da ferida operatória (13%) necrose do retalho de grande dorsal (6%). Nenhuma das pacientes apresentou complicações tardias. O período de internação variou de 1 a 5 dias. Todas as pacientes que estavam na fila do SCPMR-HUWC de cirurgia foram operadas. Conclusões: Foi verificado alto grau de satisfação por parte das pacientes operadas e bons resultados obtidos, com poucas repercussões funcionais. Assim, concluímos que os mutirões de reconstrução mamária pós-mastectomia são uma alternativa viável em termos de saúde pública.

Introduction: Despite advances in conservative surgeries, mastectomy is still a commonly performed procedure. However, many patients are unable to undergo immediate reconstruction. Such patients are integrated into a growing queue for restorative surgery. With the intention of reducing this demand, surgical Task Force programs were created. The objective of this study was to analyze the results of the second National Task Force of Breast Reconstruction (NTFBR), performed at the Plastic Surgery Service of Walter Cantídio University Hospital (SCPMRHUWC). Method: A prospective cohort study was conducted, in which 16 patients underwent breast reconstruction at SCPMRHUWC. The patients were followed up for 6 months, and their data were tabulated and analyzed. Results: All 16 female patients underwent breast reconstruction after mastectomy. The patients' ages ranged from 39 to 72 years. Among the early complications, seroma in the dorsal region (13%), partial necrosis of the mastectomy skin (6%), partial dehiscence of the operative wound (13%), and necrosis of the large dorsal flap (6%) were observed. None of the patients had late complications. The period of hospitalization ranged from 1 to 5 days. All patients who were in the SCPMR-HUWC queue for surgery were operated on. Conclusions: In this study, a high degree of satisfaction was verified by the operated patients, and good results were obtained with few functional complications. Thus, we conclude that the Task Force of breast reconstruction after mastectomy is a viable alternative in terms of public health.

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Introdução: A hérnia incisional (HI) é conceituada como qualquer falha ou orifício na parede abdominal, com ou sem protuberância, em área de cicatriz pós-operatória, diagnosticada pelo exame clínico ou de imagem. Objetivo: criar um fluxograma que, embasado por uma relevante bibliografia, oriente o tratamento de tais hérnias. Método: Trata-se de um estudo de cará ter descritivo, exploratório e observacional retrospectivo, tipo revisão integrativa. O período de coleta de dados desenvolveu-se entre os meses de janeiro e setembro de 2016, nas seguintes bases de dados: Biblioteca Virtual da Saúde: Scielo (Scientific Eletronic Library Online) e PubMed (Medical Literature Analysis and Retrieval System Online) - free full text e em língua portuguesa e inglesa - com publicaç ões realizadas no perí odo entre 2000 e 2015, por meio do seguinte descritor: incisional hernia review. Como critério de inclusão, foram selecionados os artigos cujo título indicasse alguma forma de diagnóstico, tratamento ou abordagem de HI. Após a leitura do Abstract, foram excluídos das propedêuticas os artigos que, em sua metodologia, não se apresentassem como revisão sistemática ou metanálise, culminando em nove artigos. Para a coleta de informação, todos os artigos foram lidos em sua íntegra, visando às mais variadas abordagens de HI em várias situações e sempre conferindo a referência bibliográfica. Assim, foram avaliados os artigos citados como referência entre os nove selecionados, mesmo que fossem de anos inferiores a 2000. Resultados: Foram localizados 42 artigos no Scielo e 351 no Pubmed. Foram obtidos nove artigos entre os anos 2000 e 2015 e 21 de anos anteriores. O diagnóstico, na maioria dos casos, foi clínico. Geralmente, o tratamento é cirúrgico, podendo ser por via aberta ou laparoscópica. Em ambos os casos, o uso de prótese é quase mandatório, salvo algumas exceções. Quanto maior o tamanho da hérnia, mais se tende indicar a via aberta. Nos tamanhos maiores que 15 cm, o estudo da pressão abdominal é necessário, também nos estudos com pressão maior que 10 cmH2O que sejam indicativos de procedimentos prévios ao reparo definitivo da hérnia, tais como o pneumoperitônio progressivo e a aplicação intraparietal de toxina botulínica tipo A. Nos casos de urgência, como o estrangulamento e a síndrome compartimental, a laparotomia imediata se faz necessária. Conclusões: Por meio deste estudo, pudemos criar um verdadeiro roteiro para o tratamento das Hérnias Incisionais. Tal fluxograma poderia ser adotado em qualquer centro hospitalar que cuida de tal patologia, uma vez que ele segue as recomendações vigentes em vários artigos científicos especializados no tema. (AU)

Introduction: Incisional hernia is conceptualized as any defect or orifice in the abdominal wall, with or without protuberance, in post-operative scar area, diagnosed in clinical examination or imaging techniques. Objective: create a flowchart which, based on the relevant bibliography, can be used as a guideline for the treatment of such hernias; Methods: This is a retrospective study of descriptive, exploratory and observational nature, in the manner of integrative review. The period of data collection was from January to September 2016 in the following databases: Virtual Health Library: Scielo (Scientific Electronic Library Online) and PubMed (Medical Literature Analysis and Retrieval System On-line) - free full text, in English and in Portuguese - regarding publications going from 2000 to 2015 with the following descriptor: incisional hernia review. The criterion of inclusion was the selection of articles whose titles indicated some form of IH diagnosis, treatment or approach. After reading the Abstract of the articles, we excluded those whose methodology was not a systematic review or meta-analysis, culminating in 9 articles. All articles were read in full, focusing on the different IH approaches in several situations and, in each case, examining the bibliographic reference. Thus, we examined articles indicated as reference in the 9 selected articles even when they were prior to 2000. Results 42 articles were found in Scielo and 351 in PubMed. The result was 9 articles between 2000 and 2015 and 21 articles related to previous years. In most cases, the diagnosis is clinical. The treatment is usually surgical, either in open surgery or laparoscopy. In both cases, the use of prosthetic meshes is practically mandatory, with some exceptions. The larger the hernia is, the more open surgery is recommended. In sizes above 15 cm (5.91 inches) it is necessary to examine the abdominal pressure and if it is higher than 10 cmH2O other procedures before the definitive hernia repair are recommended, such as progressive pneumoperitoneum and intraparietal application of botulinum toxin type A. In emergency cases, such as strangulation and compartmental syndrome, immediate laparotomy is required. Conclusions: This study enabled the creation of a guideline for the treatment of Incisional Hernias. The resulting flowchart could be adopted in any hospital center that addresses this pathology, since it follows the current recommendations of several specialized scientific articles. (AU)

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