RESUMO
BACKGROUND: Paralytic lagophthalmos can have devastating consequences for vision if left untreated. Several surgical techniques have been described, including the utilization of alloplastic and autologous materials. OBJECTIVES: The authors sought to evaluate the effectiveness of the surgical treatment of paralytic lagophthalmos with combined techniques employing autologous material and involving the upper and lower eyelids. METHODS: Patients with paralytic lagophthalmos underwent stretching of the levator aponeurosis with interposition of conchal cartilage in the upper eyelid associated with sectioning of the orbitomalar ligament and lateral canthoplasty in the lower eyelid. The effectiveness of the technique was evaluated employing subjective (symptomatology) and objective parameters (ophthalmologic evaluation and measurements of lagophthalmos and marginal reflex distances 1 and 2). RESULTS: Eight patients with paralytic lagophthalmos were subjected to the proposed technique. In the postoperative period, 85.7% reported complete improvement of symptoms and 62.5% presented a normal eye examination. The mean lagophthalmos measurement was reduced by 5.93 mm, the mean marginal reflex distance 2 was reduced by 2.61 mm, and the mean marginal reflex distance 1 was reduced by 0.69 mm. CONCLUSIONS: The technique presented herein, employing autologous material associated with sectioning of the orbitomalar ligament and lateral canthoplasty, was effective in the treatment of paralytic lagophthalmos and did not present significant complications, such as extrusion.
Assuntos
Ectrópio , Doenças Palpebrais , Paralisia Facial , Lagoftalmia , Humanos , Doenças Palpebrais/etiologia , Doenças Palpebrais/cirurgia , Ectrópio/etiologia , Ectrópio/cirurgia , Aponeurose , Cartilagem da Orelha/transplante , Paralisia Facial/complicações , Paralisia Facial/cirurgia , Músculos , Estudos RetrospectivosRESUMO
BACKGROUND: Breast prostheses could be associated with complications, despite many studies on surgical materials and techniques. The role of surgical drainage in preventing complications on breast prostheses surgery is controversial. OBJECTIVES: This study aimed to evaluate the role and effectiveness of vacuum drainage in the augmentation mammoplasty. METHODS: A prospective multicentric randomized comparative clinical trial was conducted with 150 patients, who were the candidates for breast augmentation. The candidates were split into two groups to analyze the breast drain role. Group1: closed-suction drainage; measurements were taken every 24 h for 48 h. Group2: control (no drainage); all the patients were submitted to a clinical and postoperative ultrasonography evaluation (7th day and 3rd month). The late consultations (1st-, 2nd-, and 3rd-year postoperative time) were carried out to identify any complication, such as infection, seroma, hematoma, asymmetry, hypertrophic scarring, rippling, implant position, visible edges, and sensibility alteration. RESULTS: A total of 150 female patients were operated with 300 breast implants placed into subglandular pocket. In the first 24 h postoperative (D1), the drainage volume ranged from 12â¯ml to 210â¯ml (mean= 74.90â¯ml; SD= 43.29â¯ml). After 24 h, on the second day (D2), the collected volume ranged from 10â¯ml to 120â¯ml (mean= 44.76â¯ml; SD= 24.80â¯ml). The total drainage volume in the 48 h ranged from 22â¯ml to 320â¯ml (mean= 119.7â¯ml; SD= 62.20â¯ml). The breast ultrasonography series (BUSGS) analysis was done on the 7th day and 3rd month in both groups. There was no significant difference between G1 and G2 groups (pâ¯=â¯0.05 and 0.25, respectively). In the follow-up, some patients (33-44%) declared sensitivity disturbing on the nipple-areola complex (NAC) and lower breast segment. CONCLUSIONS: The closed-suction breast drainage in breast augmentation was associated with high cost and time-consuming and not demonstrated any benefit in a recent postoperative time.
Assuntos
Implantes de Mama , Drenagem/métodos , Mamoplastia/métodos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Brasil , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Prospectivos , Ultrassonografia Mamária , VácuoRESUMO
BACKGROUND: Studies have demonstrated the importance of anthropometric measurements of the breasts, based on linear measurements for the selection of the volume of breast implants, their positioning, and surgical planning. OBJECTIVES: The objective of this study is to evaluate the main changes in anthropometric measurements in breast augmentation. METHODS: A prospective, randomized clinical study with 74 female candidates for breast augmentation. All the individuals were split into five groups, according to the implant volume. The implants used were of different textures, from three different brands (LifeSil, Politech, and Silimed). The following measures were taken: distance from the nipple to the inframammary fold (N-IMF), inter-nipple-areolar complex distance (N-N), distance from the Sternal notch to the Nipple (SN-N), areola diameter, and breast projection. RESULTS: The most significant breast anthropometric alteration after mammoplasty was the N-IMF distance; that is, an expansion of the lower pole of the breast, followed by an increase in the areolar diameter. Mostly of measurements showed stability between 3rd and 6th months after the surgery. The projection was the most interesting measure due to presenting two patterns of behavior according to the analysis criteria performed. When comparing the implant projection and the final breast projection, it was observed that the implant profile represented a 27% increase in the final breast projection. CONCLUSIONS: This study provides an essential comparative analysis between anthropometric changes in breast augmentations and serves as a predictive tool in the preoperative evaluation of the patient during surgical planning. 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 .
Assuntos
Implantes de Mama , Mamoplastia , Implantes de Mama/efeitos adversos , Estética , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Labiaplasty is one of the aesthetic procedures that has shown the greatest increase in the number of operations in recent years, although the absolute number of these procedures is still very low. Labia minora hypertrophy causes not only functional discomfort and sexual difficulties, but also embarrassment and aesthetic concern. The aim of this study was to assess the impact of labiaplasty on the patient's quality of life, self-esteem, and sexual function. METHODS: Twenty-four consecutive sexually active patients, who expressed the desire to undergo labiaplasty, were divided into two groups of 12 patients each: the intervention group that underwent labiaplasty immediately after responding the first questionnaires, and the control group that received no intervention during the study period. All patients were assessed for health-related quality of life, self-esteem, and sexual function using the Brazilian Portuguese versions of the Medical Outcomes Study 36-Item Short Form Health Survey, the Brazilian version of the Rosenberg Self-Esteem scale, and the Female Sexual Function Questionnaire, respectively. The questionnaires were administered at inclusion and at 3 and 6 months later in both groups. Comparisons within and between groups were performed. Statistical analysis was performed at a significance level of p < 0.05. RESULTS: No significant differences in Rosenberg Self-Esteem scale or Medical Outcomes Study 36-Item Short Form Health Survey score were found in either group during the study period. However, a significant improvement was found in the Female Sexual Function Questionnaire total score in the pain and enjoyment domains. CONCLUSION: Labiaplasty had a positive impact on sexual functioning of the study population.
Assuntos
Técnicas Cosméticas/psicologia , Qualidade de Vida , Autoimagem , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Psicogênicas/etiologia , Sexualidade , Vulva/cirurgia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Hipertrofia/complicações , Hipertrofia/psicologia , Hipertrofia/cirurgia , Pessoa de Meia-Idade , Estudos Prospectivos , Disfunções Sexuais Fisiológicas/diagnóstico , Disfunções Sexuais Fisiológicas/cirurgia , Disfunções Sexuais Psicogênicas/diagnóstico , Disfunções Sexuais Psicogênicas/cirurgia , Resultado do Tratamento , Vulva/patologia , Adulto JovemRESUMO
BACKGROUND: Dual plane breast augmentation is a technical variation of the submuscular plane described as a technique that reduces contour deformities due to contraction of the pectoralis major muscle and lower risk of double-bubble deformity associated with breast ptosis. Despite improvement in the aesthetic aspect, there is still no consensus whether this technique affects the function of the pectoralis major muscle. OBJECTIVES: The aim of this study was to correlate functional with volumetric changes associated with dissection of the muscle origin in submuscular breast augmentation. METHODS: Thirty women who desired to undergo breast augmentation were selected prospectively and randomly allocated to 2 groups: 10 patients in the control group and 20 patients in the interventional group, who underwent submuscular breast augmentation. Magnetic resonance imaging and volumetric software were used to assess muscle volume and isokinetic dynamometry was used to assess function of the pectoralis major muscle. Preoperative measurements were compared with those at 3, 6, and 12 months after surgery. RESULTS: Magnetic resonance imaging revealed significant decrease in muscle volume at 6 and 12 months follow-up. The isokinetic test conducted during adduction showed a significant difference in muscle strength between groups from baseline to the 12-month follow-up, and between the 3- and 12-month follow-up. No significant differences in muscle strength during abduction were observed from baseline to the 3-, 6-, and 12-month follow-up. CONCLUSIONS: Submuscular breast augmentation reduced muscle strength during adduction 12 months after surgery, but without a significant correlation with volumetric muscle loss.
Assuntos
Implante Mamário/métodos , Dissecação , Imageamento por Ressonância Magnética , Força Muscular , Músculos Peitorais/cirurgia , Adolescente , Adulto , Brasil , Implante Mamário/efeitos adversos , Dissecação/efeitos adversos , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/fisiopatologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Software , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Neste artigo, apresentamos um caso de uma deformidade auricular de difícil correção cirúrgica, envolvendo unidade escafo-helicoidal associada com a orelha proeminente em uma paciente de 25 anos de idade. Esta é uma malformação congênita incomum da orelha, o que resulta em uma borda helicoidal achatada, não curvilínea e dobrada sobre a escafa, comprometendo a aparência helicoidal. Foi proposto um tratamento cirúrgico com abordagem posterior e enxerto de cartilagem conchal à restauração do contorno borda helicoidal em um procedimento único. Esta nova abordagem proporciona um resultado agradável para o ouvido, principalmente por restaurar uma nova unidade escafo-helicoidal sem cicatriz na superfície orelha anterior e tratamento da orelha proeminente.
In this paper, we present a case of auricular deformity whose surgical correction is difficult, involving scapha-helical unit associated with prominent ear in a 25-year-old female patient. This is an uncommon congenital malformation of the ear, resulting in a flattened, straightened and folded helical rim over the scapha, compromising the helical appearance. The proposed surgical treatment involved posterior approach and conchal cartilage graft to the restoration of the helical rim contour in a single procedure. This new approach provides a fine result to the ear, particularly because it restores the scapha-helical unit with no scar on the surface of the anterior ear and also effectively treats the prominent ear.
Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Procedimentos de Cirurgia Plástica , Orelha , Cartilagem da Orelha , Deformidades Adquiridas da Orelha , Pavilhão Auricular , Procedimentos de Cirurgia Plástica/métodos , Orelha/anormalidades , Orelha/cirurgia , Orelha/patologia , Cartilagem da Orelha/anormalidades , Cartilagem da Orelha/cirurgia , Cartilagem da Orelha/patologia , Deformidades Adquiridas da Orelha/cirurgia , Deformidades Adquiridas da Orelha/patologia , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Pavilhão Auricular/patologiaRESUMO
BACKGROUND: Gluteal augmentation surgery has grown by 42 % per year; however, the epidemiological profile of patients who seek this treatment has never been studied. OBJECTIVE: To establish the epidemiological profile of patients who have undergone gluteoplasty surgery, evaluating their level of satisfaction and the social impact caused by the surgery. METHODS: Fifty patients, with ages ranging from 23 to 57 years replied to a specific questionnaire and the esthetic result of the surgery was evaluated. Thirty-seven patients were analyzed prospectively, using CT scans and gluteal reconstruction. The esthetic result was evaluated by eight plastic surgeon specialists from SBCP. RESULTS: About satisfaction and quality of life, 98 % of the patients demonstrated improvement in some aspect of life. Analysis of the marital status of patients showed that 24 % of them have changed it. Therefore, all cases showed positive correlations between implant size and monthly income, age and satisfaction of patients. There has also been a positive correlation between implant size and recovery time. There was no statistically significant correlation between the esthetic result and the implant volume or the anthropometric measurements. CONCLUSIONS: The epidemiological profile of patients undergoing gluteoplasty augmentation with implants is predominantly white skin, 36 years old, unrelated to the occupation or socioeconomic status. Augmentation gluteoplasty with implants is a surgery with a high level of satisfaction to patients, improving life in many aspects but, mainly, affectively. Its outcome produces a natural look and is hardly noticed by others. 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.
Assuntos
Nádegas/cirurgia , Satisfação do Paciente , Procedimentos de Cirurgia Plástica/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Autorrelato , Adulto JovemRESUMO
BACKGROUND: Besides being a procedure with high level of patient satisfaction, one of the main causes for reoperation after breast augmentation is related to contour deformities and changes in breast volume. Few objective data are available on postoperative volumetric analysis following breast augmentation. The aim of this study was to evaluate volume changes in the breast parenchyma and pectoralis major muscle after breast augmentation with the placement of silicone implants in the subglandular and submuscular planes. METHODS: Fifty-eight women were randomly allocated either to the subglandular group (n = 24) or submuscular group (n = 24) and underwent breast augmentation in the subglandular or submuscular plane, respectively, or to a control group (n = 10) and received no intervention. Volumetric magnetic resonance imaging was performed at inclusion in all participants and either after 6 and 12 months in the control group or at 6 and 12 months after surgery in the intervention groups. RESULTS: Twelve months after breast augmentation, only the subglandular group had a significant reduction in glandular volume (mean, 22.8 percent), while patients in the submuscular group were the only ones showing significant reduction in muscle volume (mean, 49.80 percent). CONCLUSIONS: Atrophy of the breast parenchyma occurred after subglandular breast augmentation, but not following submuscular breast augmentation. In contrast, submuscular breast augmentation caused atrophy of the pectoralis major muscle. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
Assuntos
Implantes de Mama , Contratura Capsular em Implantes/diagnóstico , Mamoplastia/métodos , Glândulas Mamárias Humanas/cirurgia , Músculos Peitorais/cirurgia , Adulto , Axila/cirurgia , Brasil , Estética , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Mamoplastia/efeitos adversos , Glândulas Mamárias Humanas/patologia , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Músculos Peitorais/patologia , Estudos Prospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Despite being the cosmetic procedure most performed worldwide, there are still few objective measurements of postoperative volumetric analysis of breast augmentation available in the literature. OBJECTIVE: The aim of this study was to evaluate volumetric changes in the breast parenchyma after the placement of silicone implants in the subglandular plane. METHODS: Thirty-four women were randomly allocated to the intervention group (n = 24), who underwent breast augmentation in the subglandular plane, or to the control group (n = 10), who received no intervention. Volumetric magnetic resonance imaging was performed at inclusion, and after 6 and 12 months in all participants. The non-parametric Friedman's test was used for statistical analysis. RESULTS: There was a significant reduction in glandular volume (mean, 22%) at 12 months postoperatively in patients who underwent breast augmentation. CONCLUSIONS: Breast augmentation caused reduction in the volume of the breast parenchyma. LEVEL OF EVIDENCE: 3 Therapeutic.
Assuntos
Implante Mamário/métodos , Implantes de Mama/efeitos adversos , Mama/anatomia & histologia , Géis de Silicone/farmacologia , Adolescente , Adulto , Brasil , Implante Mamário/efeitos adversos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética/métodos , Mamografia/métodos , Tamanho do Órgão/fisiologia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Valores de Referência , Medição de Risco , Géis de Silicone/efeitos adversos , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemRESUMO
In this article, the authors present a case of postrhinoplasty periorbital subcutaneous emphysema in a 35-year-old woman. This is an uncommon and benign rhinoplasty complication that can sometimes result from other pathologies such as barotrauma, hematoma, and allergic reaction. This patient's symptoms appeared to be a result of postanesthesia agitation. The patient's symptoms resolved after 1 week.
Assuntos
Rinoplastia/efeitos adversos , Enfisema Subcutâneo/etiologia , Adulto , Olho , Feminino , Humanos , Valor Preditivo dos Testes , Fatores de Risco , Enfisema Subcutâneo/diagnóstico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Body dysmorphic disorder (BDD) is a psychiatric condition often encountered by plastic surgeons in daily clinical practice. BDD is a body image disorder that causes patients to become preoccupied with small or imagined defects in appearance, which lead to the development of social and occupational disabilities. Individuals with BDD exhibit fears of their "defects" being noticed by others, and feel ashamed, embarrassed, and uncomfortable when physically exposed during social activities. They have delusional thoughts, develop compulsive rituals and somatic preoccupation, seek cosmetic treatments, and refuse psychological intervention. Patients with BDD are convinced that improving physical appearance alone will improve their self-esteem. These patients often undergo cosmetic surgery or other related procedures to correct their "defective" image, often consulting several health professionals, especially plastic surgeons, before finding one who will perform their desired procedure. However, surgery does not resolve these imperfections; on the contrary, the results are often poor and can cause the patient to develop violent behavior toward the surgeon and worsen the patient's condition. The aim of this review was to describe BDD and its progression and treatment, and to make recommendations that will assist plastic surgeons and facilitate diagnosis and patient management in daily clinicaI practice, thereby allowing patients to understand the psychogenic origin of most preoccupations with appearance and the importance of undergoing psychological/psychiatric treatment. As a result, unnecessary aesthetic procedures can be avoided.
O transtorno dismórfico corporal (TDC) é uma doença psiquiátrica que pode ser encontrada com frequência no consultório do cirurgião plástico. Trata-se de uma desordem da imagem corporal, incapacitante social e profissionalmente, em que a pessoa tem preocupações decorrentes de defeitos mínimos ou inexistentes na aparência. Indivíduos com TDC apresentam medo de terem seus "defeitos" percebidos, sentem vergonha, embaraço e desconforto ao se exporem fisicamente em atividades sociais, têm pensamentos de desilusão e desenvolvem rituais compulsivos, preocupações somáticas, busca por tratamentos cosméticos e resistência a intervenções psicológicas. Os pacientes com TDC estão convencidos de que a única maneira de melhorar sua autoestima é aperfeiçoando sua aparência. Frequentemente esses pacientes buscam a cirurgia cosmética ou outros procedimentos relacionados para melhorar seu aspecto "defeituoso", e podem consultar vários médicos, especialmente cirurgiões plásticos, até encontrarem um profissional que realizará o procedimento desejado. No entanto, a cirurgia não cura essas imperfeições, muito pelo contrário, tem resultados pobres e pode gerar violência do paciente contra o cirurgião e piora de suas condições. O propósito desta revisão é descrever a patologia do TDC, seu desenvolvimento e tratamento, e sugerir algumas recomendações aos cirurgiões plásticos para sua prática diária, a fim de facilitar o diagnóstico do transtorno e o manuseio do paciente, contribuindo para que o portador da desordem perceba a origem psíquica da maioria de suas preocupações com a aparência e aceite se submeter a um tratamento psicológico/psiquiátrico, evitando assim o procedimento estético desnecessário.
Assuntos
Humanos , Transtornos Dismórficos Corporais , Imagem Corporal , Autoimagem , Transtornos Somatoformes , Cirurgia Plástica , Terapêutica , Técnicas e Procedimentos Diagnósticos , Estética , Medo , Métodos , PacientesRESUMO
Silicone implants have been used for gluteal augmentation for the past 40 years. Several techniques have been described for cosmetic purposes, but many plastic surgeons do not feel that performing the operation is safe. In this article, a technique is described to reduce the complication rate, improve the final results, and develop an easy way of understanding and learning this procedure. Based on surgical simulation involving 10 fresh cadavers, the authors have determined the goals for making the operation simpler and safer. One hundred three patients have undergone the operation performed by the staff or by the plastic surgery resident under supervision. There was seroma in 3.88 percent, dehiscence of the sutures in 5.8 percent, infection and removal of the implant in one case (0.97 percent), and no hematoma. The patient satisfaction rate was high. Anatomical dissections allowed the authors to gain experience and confidence regarding the plane of undermining, avoiding damage to the sciatic nerve, and the placement of the prosthesis, keeping it in place. The technique is easy to understand and learn.
Assuntos
Nádegas/cirurgia , Próteses e Implantes , Implantação de Prótese , Cirurgia Plástica/métodos , Adulto , Brasil , Cadáver , Estudos de Coortes , Dissecação , Drenagem/métodos , Estética , Feminino , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Segurança do Paciente , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/fisiopatologia , Desenho de Prótese , Medição de Risco , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The transaxillary approach for breast augmentation has gained popularity because of the absence of scarring on the breast. However, the effects of this procedure on breast cancer detection and treatment (which rely heavily on the results of axillary status studies) remain under debate. Specifically, sentinel lymph node biopsy is not indicated for patients who have undergone axillary surgery, due to controversy about the interference of the axillary approach with evaluation of the axillary drainage. OBJECTIVES: The authors evaluate changes in axillary lymphatic drainage in patients who underwent transaxillary breast augmentation. METHODS: Twenty-seven patients who presented to Rio de Janeiro State University for breast augmentation were selected for this study. All patients underwent preoperative mammary lymphoscintigraphy, a subsequent transaxillary breast augmentation, and postoperative lymphoscintigraphy at 21 days and six months after the procedure. The postoperative imaging results examining the axillary lymphatic chain and the first axillary lymph node were analyzed and compared to the preoperative images. RESULTS: One of the 27 patients (4.5%) demonstrated a lower rate of lymphatic drainage at 21 days postoperatively compared to preoperative values, but the flow rate had recovered by her six-month follow-up visit. All other patients showed no changes between the preoperative and postoperative images at either time point. The sentinel lymph node remained visible in all patients at all time points, and all breasts showed drainage primarily to the axillary lymphatic chain. Two patients experienced hematoma and one patient experienced late infection at four months postoperatively. The sentinel lymph node was still evident in both axillae. CONCLUSIONS: The data showed preservation of lymphatic drainage and visible sentinel lymph nodes even after transaxillary breast augmentation. Therefore, the authors believe that this procedure does not alter the integrity of mammary drainage for properly selected patients. These data provide surgeons with a less invasive treatment option for patients with early breast cancer, even when they have undergone prior breast augmentation through a transaxillary approach.
Assuntos
Implante Mamário/métodos , Linfonodos/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Axila/diagnóstico por imagem , Axila/cirurgia , Brasil , Implante Mamário/efeitos adversos , Feminino , Seguimentos , Humanos , Linfocintigrafia , Pessoa de Meia-Idade , Estudos Prospectivos , Biópsia de Linfonodo Sentinela/métodos , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUÇÃO: Foram selecionadas aleatoriamente 25 pacientes submetidas a mamaplastia redutora pela técnica periareolar, com no mínimo 10 anos de pós-operatório. Em nenhum momento houve o espírito de avaliar comparativamente com outros tipos de técnica em uso no arsenal da cirurgia de redução e pexia mamária. OBJETIVO: Avaliar os benefícios e as desvantagens desta técnica a longo prazo. MÉTODO: Foram selecionados e analisados critérios como tamanho, formato, simetria, sensibilidade no complexo aréolo-papilar, qualidade das cicatrizes, assim como a opinião das pacientes, além do registro de complicações, reintervenções e do grau de satisfação. Todas as pacientes responderam a questionários específicos, permitindo conclusões avaliadas percentualmente para cada tipo de variável. RESULTADOS: Dentre os comentários obtidos, a maioria das pacientes concordou que se submeteria a nova mamaplastia pela técnica periareolar. O volume e a forma das mamas mantiveram-se estáveis e com elevado grau de satisfação por parte das pacientes. A queixa mais frequente foi relacionada à cicatriz. CONCLUSÃO: O resultado da análise comprovou que a abordagem periareolar é um procedimento muito útil para as mamaplastias redutoras em pacientes com pequena a média hipertrofia, sem ptose marcante e com aceitável a boa elasticidade cutânea. A principal desvantagem, entretanto, é a tendência da cicatriz ao redor da aréola alargar com o tempo.
INRODUCTION: Twenty five female patients submitted to breast reduction by periareolar approach for at least 10 years follow-up were selected. There was no intent to compare the technique with others routinely used for mammaplasty or only mastopexy. OBJECTIVE: To evaluate the benefits and disadvantages of this technique in a long term follow-up. METHODS: Several criteria were analyzed such as volume, shape, symmetry, nipple-areola complex sensibility, scars quality, as well as patient's opinion of their aesthetic results. Besides that, complications and re-intervention rates and satisfaction grade were also considered. RESULTS: The majority of the patients accepted to be submitted to mammaplasty by periareolar approach. The breasts shape and volume remained stable with a high acceptable and satisfaction rates by the patients. The main complain was related to the scar's quality. CONCLUSION: The final analysis proved that the periareolar approach is a very efficient procedure in selected group of patient with small to mild breast volume, with small to moderate ptosis and with moderate to good skin turgor. The main disadvantage of the technique is the tendency of the scar to enlarge in long term post-operative period.
Assuntos
Humanos , Feminino , Adolescente , Adulto , Mama/cirurgia , Mamoplastia/métodos , Satisfação do Paciente , Procedimentos de Cirurgia Plástica , Cirurgia Plástica , Procedimentos Cirúrgicos Operatórios , Métodos , Pacientes , Inquéritos e Questionários , Técnicas e Procedimentos DiagnósticosRESUMO
Introdução: O ramo temporal do nervo facial é um dos nervos mais comumente lesados, devido à pouca tela subcutânea que o protege a partir da sua saída da glândula parótida. Método: Vinte e cinco hemifaces de cadáveres foram dissecadas e analisadas as relações entre o ramo temporal e glândula parótida, arco zigomático, SMAS, artéria temporal superficial e músculo frontal. Resultados: Doze ramos temporais dissecados perderam a proteção da glândula parótida a uma distância de 1,7 cm anterior ao trago. O cruzamentodo arco zigomático por dois ramos temporais foi o mais frequente. A passagem pelo arco zigomático ocorreu entre 3,2 e 3,9 cm posteriores à borda lateral da órbita. O curso do ramo temporal junto às faces profundas do SMAS e da fáscia temporoparietal, e acima da lâmina superficial da fáscia temporal profunda foi constante. O ramo frontal da artéria temporal superficial foi superior e sua trajetória paralela ao ramo temporal em 92% das dissecções. Conclusão: O ramo temporal do nervo facial segue um plano constante ao longo da face profunda da fáscia temporoparietal e está muito superficial quando cruza o arco zigomático.
Background: The temporal branch of the facial nerve is one of the nerves more commonly injured due to the scarce subcutaneous tissue that protects it from its exit at the parotid gland. Method: Twenty five cadaveric hemifaces were dissected allowing a analysis of the temporal branch and: parotid gland, zygomatic arch, SMAS, superficial temporal artery and frontal muscle. Results: Twelve temporal branches exposed at a distance 1.7cm anterior to the trago. Two temporal branches crossing the zygomatic arc was the most frequent finding. This passage occurred between 3.2 to 3.9 cm posterior to the lateral border of the orbit. The trajectory of the temporal branch near the deep side of the SMAS and temporofacial fascia and above the superficial layer of the deep temporal fascia was constant. The frontal branch of the superficial temporal artery was superior and parallel to the nerve trajectory in 92% of the dissections Conclusion: The temporal branch follow a constant plane along the under surface of the temporoparietal fascia and is quite superficial as it cross the zygomatic arch.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Dissecação , Fáscia/anatomia & histologia , Fáscia/cirurgia , Nervo Facial/anatomia & histologia , Nervo Facial/cirurgia , Complicações Pós-Operatórias , Rejuvenescimento , Procedimentos Cirúrgicos Operatórios , Ferimentos e Lesões , Zigoma/anatomia & histologia , Técnicas e Procedimentos Diagnósticos , Cirurgia Geral , Métodos , RiscoRESUMO
BACKGROUND: Although the placement of implants for gluteal augmentation is becoming more common, the procedure still faces strong resistance from patients and some surgeons as a result of unsatisfactory outcomes in the past. OBJECTIVE: The authors describe easily-identifiable anatomic reference points that can assist the surgeon in the performance of gluteoplasty, making the procedure simpler and safer. METHODS: Based on a literature review, an anatomic study was performed of dissections of the gluteal region in seven formalinized and fresh cadavers. This study allowed the authors to observe anatomic details and propose bony reference points to guide gluteoplastic surgery. Between July 2006 and February 2009, 105 patients underwent gluteoplasty according to the guidelines resulting from the cadaveric study. RESULTS: All patients were female, ages 22 to 50 years. The surgical procedure, once refined, resulted in a low complication rate. In the final 50 patients in the series, there was only one seroma, one wound infection, and no cases of dehiscence. Bruising on the side of the thigh was encountered in four of the total 105 cases (3.8%). The clinical photos demonstrate the positive aesthetic results of this technique. CONCLUSIONS: When gluteoplasty is performed utilizing a systematic strategy based on bone anatomy references, it can be a predictable procedure with reproducible results and minimal complications.