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La mastectomía total por cáncer de mama produce una deformidad importante en las pacientes, con alteraciones severas de su autoestima, imagen corporal, sexualidad, y calidad de vida en general. El gold estándar en los países desarrollados es la reconstrucción mamaria inmediata y, actualmente existen pocas contraindicaciones absolutas para realizar alguna técnica de reconstrucción. Este artículo se describen las opciones reconstructivas (colgajos e implantes), tiempos de reconstrucción, ventajas y desventajas de ambas técnicas, potenciales complicaciones, y se propone un algoritmo de tratamiento. La elección de la técnica de reconstrucción debería ser decidida entre la paciente y su cirujano/a, considerando características físicas, factores relacionados con la enfermedad y tratamiento oncológico, y preferencias de las pacientes.

Total mastectomy for breast cancer treatment can be a cause of deformity and distress for patients, with severe impairment of self-esteem, body image, sexuality, and quality of life. In developing countries, immediate breast reconstruction is the gold standard, and there are only a few absolut contraindications for some technique of breast reconstruction. This article describes reconstructive options (flaps and allo-plastic material), reconstructive timing, pros and cons of both techniques, potential complications, and an algorithm of treatment is proposed. Choice of the reconstructive technique should be decided by the patient and her surgeon, considering physical characteristics, factors related with the disease and oncologic treatments, and patients' preferences.

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BACKGROUND: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an emergent disease that threatens patients with texturized breast implants. Major concerns about the safety of these implants are leading to global changes to restrict the utilization of this product. The principal alternative is to perform breast augmentation utilizing smooth implants, given the lack of association with BIA-ALCL. The implications and costs of this intervention are unknown. OBJECTIVES: The authors of this study determined the cost-effectiveness of smooth implants compared with texturized implants for breast augmentation surgery. METHODS: A tree decision model was utilized to analyze the cost-effectiveness. Model input parameters were derived from published sources. The capsular contracture (CC) rate was calculated from a meta-analysis. Effectiveness measures were life years, avoided BIA-ALCL, avoided deaths, and avoided reoperations. A sensitivity analysis was performed to test the robustness of the model. RESULTS: For avoided BIA-ALCL, the incremental cost was $18,562,003 for smooth implants over texturized implants. The incremental cost-effectiveness ratio was negative for life years, and avoided death and avoided reoperations were negative. The sensitivity analysis revealed that to avoid 1 case of BIA-ALCL, the utilization of smooth implants would be cost-effective for a risk of developing BIA-ALCL equal to or greater than 1:196, and there is a probability of CC with smooth implants equal to or less than 0.096. CONCLUSIONS: The utilization of smooth implants to prevent BIA-ALCL is not cost-effective. Banning texturized implants to prevent BIA-ALCL may involve additional consequences, which should be considered in light of higher CC rates and more reoperations associated with smooth implants than with texturized implants.

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BACKGROUND: High-definition liposculpture is a novel surgical technique widely accepted among plastic surgeons. The aim of this article is to describe surgical outcomes with a special emphasis on complications in high-definition liposculpture patients. METHODS: An historical cohort of patients who underwent high-definition liposculpture from two senior surgeons was reviewed. Technique, patient selection criteria, preoperative marks and surgical outcomes are described. Postoperative complications are discussed. RESULTS: A total of 417 patients underwent high-definition liposculpture between 2015 and 2018. Primary liposuction and secondary liposuction were performed in 308 (74%) and 109 (26%), respectively. Combined surgeries were performed in 121 cases (29%). There were no systemic complications. Local complications included hyperpigmentation (n = 276), seroma (n = 125), nodular fibrosis (n = 83), unsatisfactory definition in superficial liposuction areas (n = 16), unnatural appearance of body contour (n = 17), VASER-related burns (n = 3) and Mondor's syndrome (n = 2). Most patients (94%) were satisfied with the results. CONCLUSION: High-definition liposculpture is a body contouring technique that has shown excellent results. Despite non-serious complications were frequent, most complications were local and safely treated without affecting surgical outcome. To know these complications will help to recognize them earlier and to adjust patient expectation about the postoperative period. 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: Approximately 150 subjects per year suffer severe burns in Chile. AIM: To analyze sociodemographic/clinical features and outcomes of severely burned patients. MATERIAL AND METHODS: Retrospective cohort study of 936 patients aged 47 ± 20 years (66% males), admitted to the National Burn Center of Chile between 2006 and 2010. Sociodemographic/clinical and burn variables and outcomes were studied. RESULTS: Mean total percentage of body surface area burned was 27 + 20%. A quarter of the patients had social features that could jeopardize rehabilitation. Fire was the burning agent in 73%, which along with electricity presented greater lethality (p < 0.01). Inhalation injury was diagnosed in 22% of the patients. Twenty eight percent of patients had impaired consciousness at the moment of the accident, leading to larger burns, higher incidence of inhalation injury and greater lethality. Lethality for severe, critical and exceptional survival groups was 8.4,37.7 and 70.4%, respectively. CONCLUSIONS: Severely burned patients in Chile are mainly males at working age. Fire is the main agent and 28% had impaired consciousness, which was associated with an increase in the severity of burns. Knowledge of the characteristics and outcomes of the patients is important to implement prevention and treatment strategies adjusted to the national reality.

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Background: Approximately 150 subjects per year suffer severe burns in Chile. Aim: To analyze sociodemographic/clinical features and outcomes of severely burned patients. Material and Methods: Retrospective cohort study of 936 patients aged 47 ± 20 years (66% males), admitted to the National Burn Center of Chile between 2006 and 2010. Sociodemographic/clinical and burn variables and outcomes were studied. Results: Mean total percentage of body surface area burned was 27 + 20%. A quarter of the patients had social features that could jeopardize rehabilitation. Fire was the burning agent in 73%, which along with electricity presented greater lethality (p < 0.01). Inhalation injury was diagnosed in 22% of the patients. Twenty eight percent of patients had impaired consciousness at the moment of the accident, leading to larger burns, higher incidence of inhalation injury and greater lethality. Lethality for severe, critical and exceptional survival groups was 8.4,37.7 and 70.4%, respectively. Conclusions: Severely burned patients in Chile are mainly males at working age. Fire is the main agent and 28% had impaired consciousness, which was associated with an increase in the severity of burns. Knowledge of the characteristics and outcomes of the patients is important to implement prevention and treatment strategies adjusted to the national reality.

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INTRODUCTION: The objective is to identify whether epidemiologic differences in burns in the elderly lead to worse outcomes. METHODS: Case control study. Patients admitted between October 2006 and September 2009, comparing over 65 years old (n=66) with under 65 (n=235). Studied variables: agent, inhalation injury, total burn surface area (%TBSA), deep TBSA, proportion deep TBSA/TBSA, number of surgeries, ICU length of stay and mortality. These were compared using multivariate analysis, Mann-Whitney, proportion test and logistic regression. RESULTS: Over 65 had less TBSA, 13% (1-76) versus 22.5% (1-98) (p<0.001) in under 65 s. Deep TBSA (DTBSA) at admission had no difference, but the proportion of deep TBSA/TBSA was higher for the elderly (41% versus 23.3%) (p=0.004). Elderly patients had significantly higher mortality than patients under 65, 48% versus 24%, and had 1.9 times more probability of death (OR 2.9, CI 95% 1.6-5.2). This increased to 12 times when adjusted for TBSA and DTBSA/TBSA proportion (OR=12.02). DISCUSSION: Elderly people suffer from more severe burns at admission. The proportion of deep burns is higher. This, in association with their diminished functional reserve and social support, might explain in part their greater probability of mortality.

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