Andréia Bufoni Farah

Abdominoplasty and its effect on body image, self-esteem, and mental health.

The impact of abdominoplasty on the quality of life of abdominoplasty patients was assessed 1- and 6-months postoperatively. Forty women aged 25 to 60 years were divided into study group (25 patients who underwent abdominoplasty) and waiting-list control group (15 patients). Three questionnaires (Body Shape Questionnaire [BSQ], Rosenberg Self-Esteem Scale [RSE/UNIFESP], and Short Form 36 Health Survey Questionnaire [SF-36]) were administered to the study group (preoperatively, 1- and 6-months postoperatively) and control group (on 2 occasions 6 months apart). A significant positive impact on body image, self-esteem, and mental health was found 1- and 6-months postoperatively. Significant differences were observed in role physical, role emotional, and vitality 1-month postoperatively. In the control group, significant differences were found for vitality. There was a significant improvement in Comparative perception of body image (6-month assessment) in the study group compared with controls. Abdominoplasty improved body image, self-esteem, and mental health.

Basal cell carcinoma: an updated epidemiological and therapeutically profile of an urban population

PURPOSE To describe the epidemiological profile of basal cell carcinoma patients at a private hospital in São Paulo and to evaluate the treatment adopted. METHODS A prospective study of 202 patients, on which 253 lesions were diagnosed for histopathological exam as basal cell carcinoma within the period of January 2001 to September 2003, in the Plastic Surgery Residency Program at the Hospital Jaraguá. The susceptibility factor of the host, the environment variables, the characteristics of the lesions and the efficacy of the treatment were examined. The data were statistically evaluated. RESULTS The incidence of basal cell carcinoma was 126 cases per 100,000 patients in a period of 32 months (36 cases per 100,000 patients/year). The patients were evenly distributed in terms of sex: 48% male and 52% female. The greater incidence was in patients between the ages of 60 and 80 years and the average was 64 years. The survey revealed susceptibility factors such as white race and phototypes I and II in 95.5% of the patients. Exposition to ultraviolet radiation was reported by 77% of the patients and the most frequent location of tumors was on the face (71.2% of the cases). Actinic keratosis and a history of skin cancer were reported in 43.6% and in 25% of the cases, respectively. The adopted treatment was surgery in 99.4% of the cases and only one patient was treated with radiotherapy. Twenty lesions (8%) had incomplete excision. The recurrence rate was 2% (5 cases). There were no cases with metastasis or fatal outcome. CONCLUSIONS The factors related to the development of basal cell cancer which were significantly present in the population surveyed were: older age, white individuals, phototypes I and II, presence of actinic keratosis, previous history of non-melanoma skin cancer and exposure to ultra-violet rays both in recreational and in occupational form. The surgical treatment employed was effective with a rate of incomplete excision and recurrence similar to those found in the literature.

Isolated Primary Osteoma Cutis of the Head

Osteoma cutis is a rare disease in which there is formation of bony tissue in the skin that causes deformities. The etiology remains unknown and its treatment is controversial. A rare case of primary osteoma cutis in the face and scalp, which was not associated with any syndrome, is described. The patient was treated with surgery and topical retinoic acid. The retinoic acid treatment resulted in an improvement of the frontal area, and stabilized the disease over a two-year follow-up period. Surgical resection was a simple treatment with a quick recovery, minimal scarring and no local recurrence. The patient was followed for two years and presented a satisfactory result. The treatment of osteoma cutis is quite variable, and surgery is the most frequently reported treatment. However, a combination of clinical and surgical treatments seems to be an efficient way to manage these patients.

Suspicious node found at the time of reduction mammaplasty

Abstract. A case of a patient with a suspicious glandular node found during reduction mammaplasty is described. The preoperative search for such nodes, the management of cases on which a suspicious node is found intraoperatively, and a situation on which the diagnosis of breast cancer is made during histology are discussed. When a suspicious small node (with a diameter up to 2 cm) is detected during a cosmetic breast surgery, lumpectomy can be performed. It may be a definite surgical treatment, depending on stage and tumor type. In the case presented, histology revealed intraductal papiloma, a benign tumor, therefore lumpectomy was a suitable procedure with an acceptable cosmetic result. With the increased incidence of breast cancer, this situation will happen more often and technical options for the management of such cases deserves the attention of plastic surgeons.

Experimental model for evaluation of the cutaneous sensitivity of the abdomen

O objetivo deste estudo e relatar e divulgar um modelo experimental para avaliar diversas modalidades de sensibilidade e mapear as areas da parede abdominal nas quais ocorre diminuicao da sensibilidade apos abdominoplastia. Dois grupos de pacientes foram estudados: no grupo controle, as paciente nao apresentavam incisoes abdominais previas e as pacientes do grupo experimental tinham sido submetidas a abdominoplastia. A avaliacao da sensibilidade das pacientes do grupo experimental foi realizada de 12 a 60 meses apos a cirurgia. A pele abdominal foi dividida em doze areas, sendo nove acima e tres abaixo da cicatriz da abdominoplastia. As sensibilidades ao toque superficial, dor superficial, ao calor e frio, vibracao foram testadas e registradas como positive se a paciente referisse que sentiu o estimulo ou, caso o contrario, negativa. A sensibilidade a pressao foi testada com o uso de diferentes pesos, deste modo, um valor foi obtido quando a paciente sentia a pressao exercida pelo peso. Um teste especifico foi utilizado para testar cada modalidade de sensibilidade. O modelo experimental utilizado para testar sensibilidade da pele apos abdominoplastia mostrou-se factivel em pacientes.

Breast reconstruction in two stages with tissue expanders and silicone breast implants

Introduction: Immediate breast reconstruction with an expander/implant is a good option for women submitted to mastectomy. This study aimed to evaluate the results of immediate breast reconstruction with implants and expanders in patients who did or did not undergo postoperative radiotherapy. Methods: A consecutive prospective study that involved 83 women submitted to immediate breast reconstruction, was carried out by first performing breast reconstruction surgery with expanders and then with implants. The study was conducted between 2007 and 2012 and accounted for a total of 90 reconstructions. In the first surgery, an expander was placed in a submuscular bag under the pectoralis major and serratus muscles. In the second surgery, the expander was replaced by an implant. We compared the surgical outcomes of both types of surgeries (with implants and with expanders) in patients who underwent postoperative radiotherapy and those who did not. Results: After the first surgery, 33 patients (39.8%) received radiotherapy, and 13.25% experienced complications, including expander displacement (4.8%), emptying (2.4%), infection (2.4%), skin dehiscence (2.4%), and extrusion (1.2%). After the second surgery, 17.6% of the subjects experienced complications, including capsular contracture (7%), extrusion (5.3%), and infection (5.3%). With regard to the first surgery, 18.8% of the patients who underwent radiotherapy and 10.0% of those who did not, experienced complications. With regard to the second surgery, these prevalences were 46.6 % and 7.14%, respectively. Conclusion: Patients who received radiotherapy after breast reconstruction surgery experienced more complications.

Equipamento brasileiro de detecção gama intra-operatória para biópsia de linfonodo sentinela

OBJECTIVE: To test the effectiveness of an intra-operative gamma detection Brazilian device (IPEN) on sentinel lymph node biopsy (SLNB) procedures. METHODS: Forty melanoma or breast cancer patients with indication for undergoing SLNB were studied. Lymphoscintigraphy was done 2 to 24 hours prior to surgery. Lymphatic mapping with vital dye and gamma detection were performed intraoperatively. For gamma detection Neoprobe ® 1500 was used followed by IPEN (equipment under test) in the first 20 patients and for the remaining half IPEN was used first to verify its ability to locate the sentinel node (SN). Measurements were taken from the radiopharmaceutical product injection site, from SN (in vivo and ex vivo) and from background. It was recorded if the SN was stained or not and if it was found easily by surgeon. RESULTS: There were 33 (82.5%) breast cancer and 7 (17.5%) melanoma patients. Ages varied from 21 to 68 year-old (median age of 46). Sex distribution was 35 (87.5%) women and 5 (12.5%) men. Sentinel node was found in all but one patient. There was no statistical difference between the reasons ex vivo/ background obtained with the measures of both equipments (p=0, 2583-ns). The SN was easily found by the surgeon with both devices. CONCLUSION: The SLNB was successfully performed using either equipment. It was possible to do SLNB with the Brazilian device developed by IPEN without prejudice for the patient.