Miguel Sabino Neto

Histologic Analysis of Zafirlukast’s Effect on Capsule Formation Around Silicone Implants

BackgroundThe most common complication experienced by patients who have undergone mammary implant surgery is capsular contracture. This matter concerns physicians and patients, but to date, there is no effective way to avoid this complication. Surgical intervention usually is required. In 2002, the use of zafirlukast, a leukotriene inhibitor (a drug used for asthma treatment), was reported for the treatment of capsular contracture, with good results.MethodsFor this study, 30 female Wistar rats were used. These animals received two silicone implants each: one with a smooth surface and one with a textured surface. All the animals received daily intraperitoneal injections for 90 days and were divided as follows: control group (C) receiving only saline solution, experimental group 1 (E-I) receiving 1.25 mg/kg/day of zafirlukast, and experimental group 2 (E-II) receiving 5 mg/kg/day of zafirlukast. Histologic analysis used hematoxilin and eosin to verify vessels, capsule thickness, and inflammatory cells. Immunoistochemical analysis with smooth muscle anti-actin antibody was used for myofibroblast verification. Picro-Sirius under polarized light was used for collagen analysis.ResultsTextured implant experimental groups presented smaller numbers of vessels, thinner capsules, lower collagen density, and smaller numbers of mastocytes and eosinophils than the control group. No significant differences were found in smooth surface implants, as compared with the control group.ConclusionZafirlukast reduced the occurrence of factors directly and indirectly connected with capsular contracture.

Self-Esteem and Functional Capacity Outcomes Following Reduction Mammaplasty

BACKGROUND Both physical health and psychosocial outcomes are important issues in the evaluation of medical treatment. Women with breast hypertrophy may suffer from low self-esteem and reduced functional capacity because of the size of their breasts. OBJECTIVE The aim of this study was to evaluate the impact of reduction mammaplasty on self-esteem and functional capacity in patients with breast hypertrophy. METHODS One hundred patients with breast hypertrophy who ranged in age from 18 to 55 years and who had undergone no previous mammary surgery were selected from the Plastic Surgery Outpatient Clinic of the Federal University of São Paulo (UNIFESP-EPM). They were randomly allocated into two groups (A and B) of 50 patients each. Patients from group A were submitted for reduction mammaplasty while those from group B were placed on the waiting list and used as a control group. At the beginning of the study, all patients were interviewed to collect clinical and demographic data and to have their self-esteem and functional capacity measured. Two Brazilian-validated versions of quality of life measurement instruments were chosen: the Rosenberg Self-Esteem Scale and Rolland-Morris (to assess functional capacity). A visual analog scale (VAS) was used to evaluate pain intensity. Six months after the beginning of the study, these instruments were again administered to both groups. RESULTS Forty-six out of 50 patients from each group (A and B) completed the study. The mean age of group A was 31.6 years (SD, 11 yrs), and that of group B was 32.3 years (SD, 10 yrs). The mean weight of removed breast tissue from group A patients was 1052 g (SD, 188 g). A decrease on the score of Rosenberg Self-Esteem Scale of patients from group A indicated an improvement of self-esteem (P < .001). Functional capacity had improved 6 months after reduction mammaplasty (group A) as compared to the control group. Intensity of pain evaluated by the VAS in the lower back region decreased from 5.7 to 1.3. CONCLUSIONS Reduction mammaplasty improved self-esteem and functional capacity and relieved pain in the lower back region in patients with breast hypertrophy.

Functional capacity and postural pain outcomes after reduction mammaplasty.

Background: Neck, shoulder, and lower back pain and reduction of functional capacity can be caused by breast hypertrophy. Reduction mammaplasty appears to improve these aspects. After a systematic review of the literature, no scientific evidence was found to confirm this hypothesis. The authors’ objective was to evaluate the impact of reduction mammaplasty on pain and functional capacity of patients with mammary hypertrophy. Methods: One hundred patients with mammary hypertrophy, between 18 and 55 years old, with no previous mammary surgery, were consecutively selected from the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo–Escola Paulista de Medicina and randomly allocated into two groups. Group A (n = 50) underwent mammaplasty reduction immediately, whereas group B patients (n = 50) were placed on a waiting list (control group). All patients were interviewed for clinical and demographic data and evaluated to measure pain and functional capacity. To measure shoulder, neck, and lower back pain, a visual analogue scale (0 = no pain, 10 = unbearable pain) was used. The Stanford Health Assessment Questionnaire (HAQ-20), Brazilian validated version (0 = best, 3 = worst), was applied to assess functional capacity. Pain and functional capacity were measured at baseline and 6 months after surgery. Results: Forty-six of 50 patients, from both groups, completed the study. The mean (±SD) patient age in groups A and B was 31.6 ± 11 and 32.3 ± 10 years, respectively. The mean breast tissue weight was 1052 ± 188 g. Functional capacity in group A was improved 6 months after reduction mammaplasty, compared with group B (control), in the following aspects: getting dressed, getting up, walking, maintaining personal hygiene, reaching, and grasping objects. The mean pain intensity dropped in the lower back, from 5.7 to 1.3; in the shoulders, from 6.1 to 1.1; and in the neck, from 5.2 to 0.9. Conclusion: Reduction mammaplasty improved functional capacity and relieved pain in the lower back, shoulders, and neck of patients with mammary hypertrophy.

Quality of life after reduction mammaplasty.

Reduction mammaplasty is a common procedure in plastic surgery. Patients seek the operation for neck and lower back pain, and social and emotional problems. The evaluation of health results based on the patients opinion has become an important and reliable method for the analysis of alterations resulting from treatment. To evaluate the impact of plastic surgery on the quality of life of patients with mammary hypertrophy we used the SF‐36 standardised questionnaire in a prospective study of 44 patients preoperatively and three and six months postoperatively. There were significant improvements in seven of the eight aspects of the SF‐36 (physical function, physical role, pain, energy, social function, emotional role, and mental health). Only general health was unchanged.

Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction

With the goal of evaluating the aesthetic results, testing the reliability of the rating systems used, and determining the patients’ level of satisfaction with their breast reconstruction, pedicled transverse rectus abdominis musculocutaneous flap reconstruction was performed in 20 patients who had undergone mastectomy. The results were evaluated and compared 3, 6, and 12 months after reconstruction using the patients’ own assessments (a rating of 0–10 points) and scoring by two senior plastic surgeons (using 0–10-point global rating scales as well as the five subscales of the modified Garbay system). The interrater and intrarater agreement was poor to fair for the majority of the subscales. When evaluating by grades, there was significant difference (p < 0.001) between the patients and the raters at postoperative months 3 and 6. At month 12, one of the raters attributed significantly lower grades (p < 0.001) than the patients and the other rater. The authors observed a higher level of satisfaction by the patients than by the raters.

Brazilian version of the Body Dysmorphic Disorder Examination

CONTEXT AND OBJECTIVE Body image improvement is considered to be the main reason for undergoing plastic surgery. The objective was to translate the Body Dysmorphic Disorder Examination (BDDE) into Brazilian Portuguese and to adapt and validate this questionnaire for use in Brazil. DESIGN AND SETTING Cross-sectional survey, at the Department of Plastic Surgery of Universidade Federal de São Paulo. METHODS The BDDE was first translated into Portuguese and then back-translated into English. These translations were then discussed by healthcare professionals in order to establish the final Brazilian version. In a second stage, the validity and reliability of the BDDE were assessed. For this, patients were initially interviewed by two interviewers and subsequently, by only one of these interviewers. On the first occasion, in addition to the BDDE, the body shape questionnaire (BSQ) and the Rosenberg self-esteem scale were also applied. These questionnaires were applied to 90 patients. RESULTS Six questions were modified during the assessment of cultural equivalence. Cronbachs alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearsons coefficient showed no correlation between the BDDE and the Rosenberg self-esteem scale (0.22), whereas there was a moderate correlation between the BDDE and the BSQ (0.64). CONCLUSIONS The BDDE was successfully translated and adapted, with good internal consistency, reliability and construct validity.

Experimental model for transcutaneous electrical nerve stimulation on ischemic random skin flap in rats

Este artigo propoe o desenvolvimento de um modelo experimental para verificar o efeito da Estimulacao Eletrica Nervosa Transcutânea (TENS) na viabilidade do retalho cutâneo randomico em ratos. A amostra constituiu-se de 15 ratos, da linhagem Wistar-EPM. O retalho cutâneo randomico foi realizado com dimensoes de 10x4 cm e uma barreira plastica foi interposta entre o mesmo e o leito doador. Os animais foram submetido a TENS por 1 hora imediatamente apos a operacao e nos outros dois dias subsequentes. No setimo dia pos-operatorio foram calculadas as porcentagens de area de necrose. O modelo experimental mostrou-se factivel para estudo dos efeitos da Estimulacao Eletrica Nervosa Transcutânea em retalho cutâneo randomico em ratos.

Quilting Suture in the Donor Site of the Transverse Rectus Abdominis Musculocutaneous Flap in Breast Reconstruction

Background:The purpose of this study was to evaluate the effects of quilting suture (placement of stitches between the superficial fascia in the supraumbilical remaining flap and the musculoaponeurotic layer of the anterior abdominal wall) at the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction. Methods:There is a theory that the use of quilting suture, during the closure of the donor site with the abdominal flap, causes collapse of the dead space and enables the flap to rest, thus diminishing factors that may interfere in its adherence and help to reduce complications. Between January 2004 and March 2005, we performed 30 breast reconstructions using a unipedicled transverse rectus abdominis musculocutaneous flap. The sample was randomly distributed in 2 groups: 15 patients with quilting suture (group A) and 15 patients without quilting suture (group B). The study focused on daily drain output (mL), time to drain removal (days), and possible donor site complications (%). Results:Group A presented an average of 4.2 days for removal of the drain and group B, 6.93 days, with a statistically significant difference (P < 0.001). Concerning the total volume upon removal of the drain, group A presented an average of 434.7 mL and group B, 620.7 mL, with a statistically significant difference (P = 0.002). Group A presented 13.3% complications at the donor site and group B, 53.3%, with a statistically significant difference (P = 0.05). Conclusions:The quilting suture in this study reduces the permanence of drains, total volume of tissue fluids upon drain removal, and complication rates.

Dores na coluna: avaliação em pacientes com hipertrofia mamária

SUMMARY Objective Œ To evaluate the influence of breast hypertrophy on the incidence of back pain and how much they can interfere in patients™ daily activities. Methods Œ This was a cross-sectional analytic study in patients examined at the Outpatient Orthopedics and Plastic Surgery Departments at Samuel Libânio University Hospital in Pou-so Alegre, MG. 100 women were examined, 50 presenting breast hypertrophy (study group) and 50 with normal breast size (control group). Breasts were classified according to Sacchini™s criteria. The Numerical Rating Scale (NRS) and the Roland-Morris questionnaire were used in order to evaluate the magnitude of back pain and the limitations arising from these symptoms. Results Œ The mean age of the patients in the study group was 32.2 years and 32.7 for the control group. The scores in the NRS scale and Roland- Morris Questionnaire were higher in the study group when compared to the control group. Conclusion Œ The results achieved showed that back pain is more severe and determined more extensive limitations in the daily activities for patients presenting breast hypertrophy.

Effect of zafirlukast on capsular contracture around silicone implants in rats

PURPOSE To evaluate the effect of zafirlukast on capsular contracture around silicone implants by measuring the pressure within the implant, using a rat experimental model. METHODS Forty adult female Wistar rats were used. Each one received two silicone implants, one with smooth-surface and the other with textured-surface. They were randomly divided into four groups (n=10). The rats of control group I were sacrificed after the implants. The remaining animals were subjected to a daily regimen of intra-peritoneal injection for a period of 90 days and they were distributed as follows: control group II received 0.9% physiological saline solution; experimental group I received zafirlukast 1.25 mg/kg; and experimental group II received zafirlukast 5 mg/kg. The measurement of intra-implant pressure of control group I was determined on the surgery day and in other groups on the ninetieth day, after being sacrificed. RESULTS In the evaluation of textured implants there was an increase of internal pressure in the control group II, and there was no increase in the experimental groups. Compared to the controls there were not significant differences in smooth implants. CONCLUSION Zafirlukast reduced the risk of developing capsular contracture around silicone implants with textured surface.