Ana Claudia Weck Roxo

Evaluation of the Effects of Silicone Implants on the Breast Parenchyma

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 Friedmans 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.

Evaluation of the effects of transaxillary breast augmentation on sentinel lymph node integrity.

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.

Functional and Volumetric Analysis of the Pectoralis Major Muscle After Submuscular Breast Augmentation

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. Level of Evidence 2

Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation.

Reply: Volumetric Evaluation of the Mammary Gland and Pectoralis Major Muscle following Subglandular and Submuscular Breast Augmentation Sir: We appreciate the authors’ interest in our article.1 Although we could evaluate the effect of the submuscular breast implant on the mammary gland and on the pectoralis major muscle, we in fact could not evaluate the effect of subglandular implants on the muscle, because we did not measure volumetric variations on the muscle in the subglandular group. We are working on this issue already. We agree that physical activity is important for muscle volume, and because of that, all patients included in this series were practicing daily physical activity (at least three times per week), but none of them were bodybuilders. In this manner, all of the patients returned to their daily activity after 45 days postoperatively (also at least three times per week). Besides that, none of them had any functional complaint postoperatively that justifies muscular disuse. Another study is already being conducted at the university to correlate the size of the implants with the grade of parenchyma2 and muscular volume loss, and further studies are planned to correlate parenchyma density with volume loss. DOI: 10.1097/PRS.0000000000002438

Utility of Video-Assisted Endoscopy in Transaxillary Breast Augmentation

BACKGROUND Breast augmentation through incisions in the axillae is an option for patients who wish to avoid scars on the breasts. The axillary approach also preserves the mammary parenchyma and lactiferous ducts. The utility of video-assisted endoscopy during this procedure as a means to improve safety and aesthetic outcomes remains debatable. OBJECTIVES The authors compared outcomes of transaxillary breast augmentation with and without video-assisted endoscopy. METHODS Thirty-four women who underwent transaxillary breast augmentation with or without video-assisted endoscopy were evaluated in a prospective, randomized study. Patients received high-profile silicone implants in the subglandular plane and were monitored for an average of 25 months. Operating time, complication rates, postoperative pain, patient satisfaction, and aesthetic parameters were evaluated. RESULTS Operative time were significantly longer for patients who underwent transaxillary breast augmentation with video-assisted endoscopy compared with patients who underwent nonendoscopic surgery. CONCLUSIONS Video-assisted endoscopy increased operating time but did not improve the safety of transaxillary breast augmentation or yield better aesthetic outcomes. LEVEL OF EVIDENCE 3 Therapeutic.

Endocrine-Metabolic Response in Patients Undergoing Multiple Body Contouring Surgeries After Massive Weight Loss

BACKGROUND The endocrine-metabolic response to trauma is directly related to its magnitude, but little is known about the adverse effects of combined surgical procedures on morbidity. OBJECTIVES The authors sought to evaluate risk factors by measuring the endocrine-metabolic response in patients who underwent multiple body-contouring surgeries after massive weight loss. METHODS This prospective, randomized, interventional study included 46 massive weight loss patients who experienced a weight loss >30% of their body mass index (BMI) and were referred for body contouring surgery. Patients were randomly allocated to the control group (n = 10) or intervention group (n = 36), which in turn was divided into 3 subgroups (n = 12, each) according to BMI, surgical time, and scar length values. Blood samples were collected from all patients at different time points to assess biological stress markers. RESULTS Levels of IL-6 in patients in the higher ranges of BMI and operating time and with more extensive scar length were significantly higher in the immediate postoperative period compared with baseline. Concentrations of noradrenaline were significantly higher 24 hours after surgery compared with baseline only in patients in the higher range of operating time. A higher level of IL-6 at 72 hours after surgery compared with baseline was associated with more extensive scar length. Levels of other biological stress markers did not significantly differ. CONCLUSIONS The combination of surgical procedures did not significantly affect the concentrations of most biological stress markers. The variable of operating time most influenced increase in plasma concentrations of stress markers. LEVEL OF EVIDENCE: 1

Evidence-Based Medicine in Plastic Surgery: Are We There Yet?

Background The practice of evidence-based medicine in plastic surgery is no longer a trend but a reality, with a growing number of studies published in recent years using evidence-based medicine as an assessment tool. Objective The aim of this study was to verify whether the number of citations to articles with a high level of evidence is greater than articles with low level of evidence. Methods A search was conducted in the 4 main international journals of plastic surgery. All original articles published in 2011 were analyzed, selected, and classified based on the study design. The articles were then divided into 2 groups: group 1, high level of evidence; and group 2, low level of evidence. Next, Scopus was searched for the number of citations of each article in the 2 subsequent years. The proportion of the number of citations received by articles in groups 1 and 2 was statistically compared. Results The articles with the highest level of evidence were the most cited among original articles, with 48.6% of them being cited more than 10 times over 2 years, whereas only 18.4% of articles in group 2 were cited with the same frequency. The mean number of citations was 12.6 citations per article in group 1 and 6.56 citations in group 2, with a significant difference between groups (P < 0.0001). Conclusions The articles with a higher level of evidence are, on average, cited more often than those with low levels of evidence in the leading journals of plastic surgery.

Response to "Misconceptions of Capsular Contracture, Operative Times, and Complications in the Transaxillary Breast Augmentation Literature".

First of all, the authors would like to thank Dr. Gelfant for his Letter to the Editor.1 Ours was a level 3 of evidence article,2 based on the method utilized in evidence-based medicine to determine the clinical value of a study, but there is some misunderstanding about the aim of the paper. Unlike you described in your letter, the objective of the study was not to evaluate if the endoscopic-assisted transaxillary breast augmentation is a good technique, but to compare both procedures (endoscopic-assisted and without endoscopic technique) when performing an axillary breast augmentation. We cannot …

Restoring the Neck Contour

To restore neck contour, we do not favor the following procedures: Submandibular gland resections: Operations on the submandibular gland may yield severe complications, and the benefits are not worth the risk. Digastric muscle operations: We see no advantages to operations on the digastric muscles. They are masticatory muscles. To provide the best outcome for the patient, the surgeon must respect the complexity and variance of neck defects, the limitations of each case, and the surgeon’s own limitations.

Reconstrução de parede abdominal com tela aloplástica após infecção por micobactéria

The present report is a case study of a 51-year-old woman who underwent hysterectomy by videolaparoscopy, and eventually developed a mycobacterial infection. Treatment comprised antimicrobial administration, surgical debridement, and reconstruction of the abdominal wall with a synthetic mesh. During the postoperative period, the herniation of the abdominal wall required substitution of the mesh and subsequent abdominoplasty. This case report indicates the importance of preventing mycobacterium infection and provides treatment guidelines to optimize functional and aesthetic results.