RESUMO
Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM and differences between clinical risk factors, breast volume, and different incision types. In a cohort-designed study, 158 reconstructed patients (invasive/in situ cancer and high risk for cancer) were stratified into groups based on different types of incision used (hemi-periareolar, double-circle periareolar, and Wise-pattern). They were matched for age, body mass index, associated clinical diseases, smoking, and weight of specimen. Also included were patients treated with adjuvant chemotherapy and postoperative radiotherapy. Mean follow-up was 65.6 months. In 106 (67 %) patients, NSM was performed for breast cancer treatment and in 52 (32.9 %) for cancer prophylaxis. Thirty-nine (24.6 %) patients were submitted to hemi-periareolar technique, 67 (42.4 %) to double-circle periareolar incision, and 52 (33 %) to Wise-pattern incision. The reconstruction was performed with tissue expander and implant-expander. Local recurrence rate was 3.7 % and the incidence of distant metastases was 1.8 %. Obese patients and higher weight of specimen had a higher risk for complications. After adjusting risk factors (BMI, weight of specimen), the complications were higher for patients submitted to hemi-periareolar and Wise-pattern incisions. This follow-up survey demonstrates that NSM facilitates optimal breast reconstruction by preserving the majority of the breast skin. Selected patients can have safe outcomes and therefore this may be a feasible option for breast cancer management. Success depends on coordinated planning with the oncologic surgeon and careful preoperative and intraoperative management. Surgical risk factors include incision type, obesity, and weight of breast specimen.
Assuntos
Implante Mamário/métodos , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mamilos/cirurgia , Adulto , Idoso , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Quimioterapia Adjuvante , Estudos de Coortes , Feminino , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação , Fatores de Risco , Dispositivos para Expansão de Tecidos , Resultado do TratamentoRESUMO
BACKGROUND: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. METHOD: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. RESULTS: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval = 1.01-7.00; P = 0.049). CONCLUSIONS: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Satisfação do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Mastectomia Segmentar , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Obesidade/complicações , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fatores de TempoRESUMO
Although the biodimensional anatomical expander-implant system (BEIS) is a reliable technique, little information has been available regarding outcome following nipple-areola sparing mastectomy (NSM). To perform the resection of glandular tissue, while improving the surgical access and maintaining the nipple-areola vascularization we have developed a new approach for NSM based on the double concentric periareolar incision (DCPI). The purpose of this study is to analyze the feasibility, surgical planning and its outcome following NSM. 18 patients underwent NSM reconstructions. Mean time of follow-up was 29 months. The technique was indicated in patients with small/moderate volume breasts. Flap complications were evaluated and information on aesthetic results and patient satisfaction were collected. 83.3% had tumors measuring 2cm or less (T1) and 72.1% were stage 0 and I. All patients presented peripherally tumors located (at least 5cm from the nipple). Skin complications occurred in 11.1%. One patient (5.5%) presented small skin necrosis and a wound dehiscence was observed in one patient (5.5%). The aesthetic result was good/very good in 94.4 percent and the majority of patients were very satisfied/satisfied. No local recurrences were observed. All complications except one were treated by a conservative approach. DCPI-BEIS is a simple and reliable technique for NSM reconstruction. The success depends on patient selection, coordinated planning with the oncologic surgeon and careful intra-operative and post-operative management.
Assuntos
Implante Mamário , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Lobular/cirurgia , Mastectomia/métodos , Expansão de Tecido , Adulto , Implantes de Mama , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Mamilos/cirurgia , Resultado do TratamentoRESUMO
The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management.
Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia Segmentar , Adulto , Neoplasias da Mama/radioterapia , Carcinoma in Situ/patologia , Carcinoma in Situ/radioterapia , Carcinoma in Situ/cirurgia , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/cirurgia , Terapia Combinada , Fracionamento da Dose de Radiação , Secções Congeladas , Humanos , Pessoa de Meia-Idade , Reoperação , Estudos RetrospectivosRESUMO
Although breast reconstruction with deep inferior epigastric perforator (DIEP) flap is a well-described technique, few publications have specifically reported the technical aspects and the outcome following skin-sparing mastectomy (SSM). The aim of this study is to analyse the feasibility of its immediate application and to describe the operative planning, outcome and complications after SSM. 27 patients underwent 30 DIEP flap breast reconstructions with all immediate and 3 bilateral. Mean time of follow-up was 29 months. Breast skin, DIEP Flap and donor-site complications were evaluated. Information on patient satisfaction was collected. 70% had tumors measuring 2 cm or less (T1) and 74% were stage 0 and I according to American Joint Committee on Cancer. Breast skin complications occurred in 7.4%, all represented by small areas of skin necrosis. Partial losses were observed in two (7.4%) patients (less than 15% of total area) and total DIEP loss in 1 (3.7%). Donor-site complications represented by bulging occurred in only one patient (3.7%). The majority of patients were either very satisfied or satisfied. One local recurrence was observed. All complications except 2 were treated by a conservative approach. The DIEP flap is a reliable technique for SSM reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon and careful intraoperative and postoperative management. The main advantage is that patients can safely undergo dual procedures with the added aesthetic benefits in breast and abdominal donor site.
Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Adulto , Neoplasias da Mama/patologia , Feminino , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Retalhos Cirúrgicos/efeitos adversosAssuntos
Neoplasias Abdominais/diagnóstico , Parede Abdominal , Endometriose/diagnóstico , Neoplasias Abdominais/patologia , Neoplasias Abdominais/cirurgia , Dor Abdominal/diagnóstico , Parede Abdominal/patologia , Adulto , Cesárea , Diagnóstico Diferencial , Endometriose/patologia , Feminino , Humanos , Lipectomia , Tomografia Computadorizada por Raios XRESUMO
The objective of this study is to describe the surgical planning of the inferior dermoglandular pedicle (IDP) technique and its outcome following partial mastectomy reconstruction. A total of 26 patients with breast cancer underwent immediate IDP reconstruction. IDP was indicated to reconstruct superior/central breast defects. Postoperative complications were evaluated and information on esthetic result and satisfaction were collected. About 57.6 percent had tumors measuring 2cm or less (T1). Immediate complications occurred in 34.2 percent with skin necrosis in 11.4 and dehiscence in 7.6 percent. Late complications were observed in 11.4 percent. The cosmetic result was considered to be good or very good in 88.4 percent and the majority of patients were satisfied. All complications were treated by conservative approach. IDP is a reliable technique and should be given consideration in cases of superior/central quadrant reconstruction. The success of the procedure depends on patient selection and careful intra-operative management.
Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Glândulas Mamárias Humanas/cirurgia , Mastectomia Segmentar , Neoplasias da Mama/patologia , Procedimentos Cirúrgicos Dermatológicos , Feminino , Humanos , Estadiamento de Neoplasias , Satisfação do Paciente , Complicações Pós-Operatórias , Reprodutibilidade dos Testes , Deiscência da Ferida Operatória , Infecção da Ferida Cirúrgica , Resultado do TratamentoAssuntos
Adulto , Feminino , Humanos , Neoplasias Abdominais/diagnóstico , Parede Abdominal , Endometriose/diagnóstico , Neoplasias Abdominais/patologia , Neoplasias Abdominais/cirurgia , Dor Abdominal/diagnóstico , Parede Abdominal/patologia , Cesárea , Diagnóstico Diferencial , Endometriose/patologia , Lipectomia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Although use of the latissimus dorsi myocutaneous flap associated with the Biodimensional anatomical expander implant system (McGhan 150) is a reliable technique, little information has been available regarding clinical outcome following periareolar skin-sparing mastectomy reconstruction. The purpose of this study was to analyze the feasibility of the technique, surgical planning, and its outcome following skin-sparing mastectomy. METHODS: Thirty-two patients underwent immediate unilateral latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system breast reconstruction. Mean follow-up was 18 months. The technique was indicated in patients with small- or moderate-volume breasts with or without ptosis, in whom the use of abdominal flaps was precluded. Flap and donor-site complications were evaluated. Information on anesthetic results and patient satisfaction was collected. RESULTS: Seventy-two percent had tumors measuring 2 cm or less (T1) and 78 percent were stage 0 and I according to American Joint Committee on Cancer criteria. Breast skin complications occurred in 9.4 percent. Two patients presented small breast skin necrosis, and in one patient, a wound dehiscence was observed. Donor-site complications, all represented by seroma, occurred in 12.5 percent. The cosmetic result was considered good or very good in 84.4 percent, and the majority of patients were either very satisfied or satisfied. No local recurrences were observed. All complications except two were treated by conservative means. CONCLUSIONS: The latissimus dorsi myocutaneous flap/Biodimensional anatomical expander implant system is a simple and reliable technique for periareolar skin-sparing mastectomy reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative and postoperative management.
Assuntos
Implantes de Mama , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Músculo Esquelético/transplante , Adulto , Brasil , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Estudos de Coortes , Terapia Combinada , Estética , Feminino , Seguimentos , Humanos , Mamoplastia/efeitos adversos , Mastectomia Subcutânea/efeitos adversos , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Satisfação do Paciente , Seleção de Pacientes , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Medição de Risco , Retalhos Cirúrgicos , Dispositivos para Expansão de Tecidos , Cicatrização/fisiologiaRESUMO
BACKGROUND: The transaxillary approach plays a useful role for breast augmentation due to scar placement in a less visible position. However, the future impact of the procedure on the lymphatic drainage patterns and sentinel lymph node (SLN) detection remains controversial. To date, no information is available regarding the feasibility of SLN identification in patients with previous transaxillary breast augmentation (TBA). METHODS: Twenty-six patients underwent primary TBA. Mean follow-up was 8.3 months. All patients were submitted to lymphoscintigraphy (LSG), with a dose of 0.1 mCi 99m-technetium-labeled dextran 1 week before (preop-LSG) and 10 days (Po10 days-LSG) after TBA. RESULTS: Preop-LSG was successful in all patients. Mean number of SLN detected was 2 per patient (range, 1 to 4) in the right axilla and 2.2 (range, 1 to 5) in the left. In Po10 days-LSG, SLN detection was successful in 92.3%. Mean number of SLN detected was 2.3 per patient (range, 0 to 7) in the right axilla and 1.8 (range, 0 to 6) on the left. Two patients (7.6%) failed to reveal the accumulation of radioactivity in Po10 days-LSG. Comparing bilaterally, in the number of SLN detected (P = 0.838) and the SLN uptake (P = 0.067) between Preop-LSG and Po10 days-LSG, no significant differences were observed. No major complication was noted. CONCLUSION: The initial data illustrate that SLN detection in the setting of prior TBA is feasible in a great part of patients. Additional long-term studies are necessary to investigate the accuracy of SLN biopsy in subgroups of breast cancer patients with previous breast implants.
Assuntos
Implantes de Mama , Linfonodos/diagnóstico por imagem , Linfa/fisiologia , Mamoplastia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Biópsia de Linfonodo Sentinela , Adulto , Axila/diagnóstico por imagem , Axila/cirurgia , Estudos de Coortes , Dextranos , Estudos de Viabilidade , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Estudos Prospectivos , Cintilografia , Géis de Silicone , Compostos de TecnécioRESUMO
Breast radiotherapy during childhood may cause unpredictable outcomes in soft tissue growth and may be responsible for most iatrogenic-related breast hypoplasias. Poor local skin quality and subcutaneous atrophy poses a difficult problem for the use of alloplastic tissues. Clinical use of a deep inferior epigastric perforator flap (DIEP) in oncological breast surgery is a common practice; however few studies have described its application in benign situations and no previous report addressed this subject. The authors indicate the use of the DIEP flap to correct severe hypomastia after previous childhood radiotherapy for hemangioma treatment, followed by unsuccessful alloplastic tissue reconstruction. For selected patients the DIEP flap may constitute a new alternative for complications of radiotherapy treatment due to the possibility of large tissue transfer with minimal donor area morbidity. The quantity of flap tissue necessary to restore the breast mound, the perforator vessel size, and the quality of suitable recipient vessels should be carefully evaluated. However, the need for microsurgical training as well as the extended surgical time are the main limiting factors for the use of this flap.
Assuntos
Mama/patologia , Mama/cirurgia , Artérias Epigástricas/transplante , Mamoplastia , Radioterapia/efeitos adversos , Retalhos Cirúrgicos , Adulto , Mama/efeitos da radiação , Neoplasias da Mama/radioterapia , Feminino , Hemangioma/radioterapia , Humanos , Reto do Abdome/irrigação sanguínea , Reto do Abdome/transplante , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Breast conservation surgery and postoperative radiotherapy are widely accepted as the treatment of choice for patients with early breast cancer. Despite its oncologic benefits, the radiotherapy may cause unpredictable outcomes in soft tissues, especially in patients undergoing breast reconstruction. Described recently, intraoperative irradiation (IORT) has been indicated for selected patients as an alternative to radiotherapy with fewer adverse local effects. Clinical use of reduction mammaplasty (RM) techniques in oncologic breast surgery has been described previously. However, no previous studies have mentioned its application after breast conservation surgery and IORT. METHODS: The authors used RM to reconstruct a partial breast tissue defect secondary to breast conservation surgery followed by IORT treatment in a 46-year-old patient with an 11-mm invasive ductal carcinoma between the superior internal quadrants of the right breast. RESULTS: Satisfactory breast volume and shape were achieved, and no immediate or late complications were observed. After 2 postoperative years, no evidence of fat necrosis, tumor recurrence, or tissue volume loss was observed. CONCLUSION: The initial data indicate that RM in the setting of breast conservation surgery reconstruction and IORT is feasible. With appropriate patient selection, respecting indications and limitations, RM has its place among the various reconstructive techniques. Additional studies with larger clinical series and longer follow-up periods are necessary to analyze the precise IORT effects in patients submitted to immediate breast conservation surgery reconstruction.
Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Período Intraoperatório , Mamoplastia , Mastectomia Segmentar , Adulto , Terapia Combinada , Feminino , HumanosRESUMO
BACKGROUND: Reduction mammaplasty procedures and especially the superior-medial dermoglandular pedicle (SMDP) technique are frequently used for esthetic objectives; however, few reports have been available regarding its application following conservative breast surgery reconstruction. The purpose of this study is to analyze the feasibility of the technique and describe the surgical planning and its outcome following oncologic surgery. METHODS: Thirty-nine patients underwent immediate bilateral SMDP breast reconstructions. Mean time of follow-up was 20 months. SMDP was indicated to reconstruct inferior breast defects in patients with enough remaining breast tissue. Reconstructed (RB) and opposite (OB) breast complications were evaluated and information on esthetic result and patient satisfaction was collected. RESULTS: Tumors (51.2%) measured 2 cm or less (T1) and 66.6% were located in the lower outer quadrants. Mean change in nipple position was 12.5 cm. Immediate RB complications occurred in 8 patients (20.5%), with skin necrosis in 3 (7.6%), infection in 2 (5.1%), dehiscence in 2 (5.1%), and partial areola necrosis in 1 (2.5%) patient. Late complications were observed in 7.6%. All late complications were observed after adjuvant radiotherapy. The cosmetic result was considered to be good or very good in 84.6%, and the majority of patients were either very satisfied or satisfied. All complications were treated by conservative approach. CONCLUSION: SMDP is a reliable technique and should be given primary consideration in cases of lower quadrant reconstruction. The success of the procedure depends on patient selection, coordinated planning, and careful intraoperative management.
Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Mamoplastia/métodos , Glândulas Mamárias Humanas/cirurgia , Adulto , Neoplasias da Mama/radioterapia , Carcinoma Ductal de Mama/radioterapia , Procedimentos Cirúrgicos Dermatológicos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Necrose/cirurgia , Satisfação do Paciente , Complicações Pós-Operatórias , Pele/patologiaRESUMO
BACKGROUND: Although transaxillary breast augmentation (TBA) is a well-studied procedure, few previous reports exist concerning the subfascial technique, especially without endoscopic assistance. This study aimed to analyze the feasibility of the technique after breast augmentation in terms of its indication, surgical technique, limitations, and clinical outcome. METHODS: For this study, 42 patients underwent TBA without endoscopic assistance. The technique was indicated for patients with breasts of small or moderate volume without ptosis, patients who wanted no breast scars, and patients who had a poorly defined inframammary fold. The mean follow-up period was 16 months. Implant and incision approach complications were evaluated. Information on patient satisfaction was collected. RESULTS: A total of 14 complications occurred in 42 patients, all of them minor. Axillary incision-related complications occurred in 26% of the patients, as represented by a late axillary subcutaneous band (119%), sensory loss in the inner aspect of the arm (71%), and a hypertrophic scar and small wound dehiscence (71%). No patient presented with capsular contracture, visible rippling, or infection. Most of the patients (93%) were either very satisfied or satisfied with their result, and none regretted the surgery. CONCLUSION: The TBA procedure without endoscopic assistance is a simple and reliable technique for breast augmentation. Most of the complications in this study were minor and predictable. They did not interfere with the aesthetic outcome nor the normal postoperative recovery. With TBA, success depends on patient selection as well as careful intra- and postoperative management.
Assuntos
Axila/cirurgia , Implante Mamário , Endoscopia , Fasciotomia , Mamoplastia/métodos , Adolescente , Adulto , Estética , Feminino , Humanos , Complicações Pós-Operatórias/epidemiologia , Inquéritos e Questionários , Resultado do TratamentoRESUMO
BACKGROUND: Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival METHODS: Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected RESULTS: Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. CONCLUSION: CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Mamoplastia/métodos , Técnicas de Diagnóstico por Cirurgia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Although the lateral thoracodorsal fasciocutaneous flap is a well-studied procedure for late breast reconstruction following radical surgery, there are few previous reports regarding its indication, flap design, and clinical outcome following conservative breast surgery. METHODS: Thirty-four patients underwent immediate unilateral lateral thoracodorsal fasciocutaneous flap breast reconstructions. Mean time of follow-up was 23 months. The lateral thoracodorsal fasciocutaneous flap was indicated to reconstruct moderate lateral breast defects where there was not enough breast tissue to perform the reconstruction. Flap and donor-site complications were evaluated. Information on aesthetic results and patient satisfaction was collected. RESULTS: All tumors were located in lateral breast regions, and 64.7 percent measured 2 cm or less (T1). Flap complications occurred in four patients (11.8 percent), with partial flap necrosis in three (8.8 percent). Donor-site complications occurred in eight (23.5 percent), with seroma in five (14.7 percent) and wound dehiscence in three (8.8 percent). The cosmetic result was considered to be good or very good in 88.2 percent, and the majority of patients were either very satisfied or satisfied. Surgical intervention was necessary in two cases of wound dehiscence. Serial dorsal puncture in cases of seroma were performed with satisfactory results. CONCLUSIONS: The lateral thoracodorsal fasciocutaneous flap is a simple and reliable technique for conservative breast surgery reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.
Assuntos
Mamoplastia/métodos , Retalhos Cirúrgicos , Adulto , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Quimioterapia Adjuvante , Cicatriz/etiologia , Terapia Combinada , Estética , Necrose Gordurosa/etiologia , Feminino , Fibrose , Humanos , Excisão de Linfonodo , Mamoplastia/efeitos adversos , Mamoplastia/estatística & dados numéricos , Mastectomia , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Reoperação , Estudos Retrospectivos , Seroma/etiologia , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/estatística & dados numéricos , Deiscência da Ferida Operatória/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
BACKGROUND: Although reduction mammaplasty is a well-described technique for aesthetic purposes, there are few previous reports regarding its application and clinical outcome following conservative breast surgery reconstruction. The purpose of this study was to analyze the feasibility of the technique and its outcome following conservative breast surgery. METHODS: Oncologic data and information on age, body mass index, smoking history, and comorbid conditions were collected. Reconstructed and opposite breast complications were evaluated. Reduction mammaplasty was indicated to reconstruct moderate breast defects in patients with enough remaining breast tissue. Mean follow-up was 22 months. RESULTS: Seventy-four patients underwent immediate reduction mammaplasty following breast-conserving surgery. In 55.4 percent of patients, tumors measured 2 cm or less (T1) and in 47.2 percent they were located in the upper outer quadrants. Breast complications occurred in 13 patients (17.6 percent), with skin necrosis in six (8.1 percent), infection in two (2.7 percent), partial areola necrosis in two (2.7 percent), dehiscence in two, and total areola necrosis in one (1.35 percent). Late complications represented by skin lesions and fat necrosis were observed in five patients (6.8 percent). Obese patients and smokers had a significantly higher rate of reconstructed breast complications compared with the normal/overweight patients (p = 0.002) and nonsmokers (p = 0.043). No significant association between complications and age, hypertension, diabetes, axillary lymph node dissection, or chemotherapy was found. CONCLUSIONS: Reduction mammaplasty is a consistent technique for reconstruction following breast-conserving surgery. Complications are more often observed in the reconstructed breast, and obese patients and smokers are higher risk patients.
Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia , Mastectomia Segmentar , Adulto , Idoso , Neoplasias da Mama/epidemiologia , Carcinoma Ductal de Mama/cirurgia , Quimioterapia Adjuvante , Comorbidade , Estudos de Viabilidade , Feminino , Humanos , Excisão de Linfonodo , Mamoplastia/métodos , Pessoa de Meia-Idade , Obesidade/epidemiologia , Dosagem Radioterapêutica , Radioterapia Adjuvante , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologiaRESUMO
BACKGROUND: Although breast reconstruction with the deep inferior epigastric perforator (DIEP) flap is a well-known technique, few publications have reported the aesthetic outcome of the abdomen and the donor-site closure techniques utilized. The aim of this study was to analyze the feasibility of immediate clinical application of traditional abdominoplasty techniques after DIEP flap harvesting. METHODS: Forty-four patients underwent 48 DIEP flap breast reconstructions, with 32 immediate and four bilateral procedures. All patients underwent full abdominoplasties with some technique of musculoaponeurotic system plication. Information on age, weight, height, smoking status, comorbid medical conditions, complications, and revision surgery was collected. RESULTS: In all patients, the anterior rectus fascia was closed by a two-layer imbrication-type closure and the rectus diastasis was corrected by a median plicature. In 36 patients (81.8 percent), a contralateral rectus plicature was performed. In 21 patients (47.7 percent), plication of the external oblique aponeurosis was performed. All patients achieved an improved abdominal contour, and 41 (93.2 percent) were satisfied with their result. Ten patients (22.7 percent) had minor complications. CONCLUSIONS: Clinical application of abdominoplasty techniques is feasible immediately after DIEP harvesting and must address not only skin and subcutaneous tissue but also the muscular abdominal wall. All of the musculofascial plication techniques improved the definition of the waistline. Patient selection is crucial to achieve a satisfactory outcome. The main objective is that patients safely undergo dual procedures with no increased risk and with the added aesthetic benefits at the abdominal donor site.