Rodrigo Cericatto

Sexual function and chemotherapy in postmenopausal women with breast cancer

BackgroundThis cross-sectional, nested cohort study assessed Female Sexual Function Index (FSFI) scores in postmenopausal women with breast cancer receiving primary chemotherapy.MethodsThe FSFI questionnaire was administered to 24 postmenopausal women one month after diagnosis of breast cancer (post-diagnosis group) and one month after completion of the first cycle of primary anthracyclin-based chemotherapy (post-chemotherapy group). Scores were compared to those of 24 healthy postmenopausal women seeking routine gynecological care (control group). All patients were sexually active at the time of enrollment. Mean age was 57.29 ± 11.82 years in the breast cancer group and 52.58 ± 7.19 years in the control group.ResultsScores in all domains of the FSFI instrument were significantly lower in the post-diagnosis group than in controls (−41.3%, p < 0.001). A further major reduction in FSFI scores was evident on completion of one cycle of primary chemotherapy (down 46.7% from post-diagnosis scores, p < 0.003), again in all domains. Six patients (25%) ceased all sexual relations, in a significant change from baseline (p < 0.001). After one chemotherapy cycle, a further five patients ceased sexual activity, for a total of 11 (45.8%) participants – a borderline significant difference (p = 0.063).ConclusionThe present study shows that female sexual function as assessed by the FSFI declines significantly at two distinct points in time: upon diagnosis of breast cancer and after administration of systemic chemotherapy.

Tumor Size as a Surrogate End Point for the Detection of Early Breast Cancer: A 30-Year (1972–2002), Single-Center Experience in Southern Brazil

Abstract:  The 30‐year experience in improving detection of breast cancer in the Breast Unit of the Hospital de Clínicas, Federal University of Rio Grande do Sul, Brazil (1972–2002) is reported. We retrospectively analyzed the behavior of surrogate parameters of early breast cancer detection, such as the mean tumor diameter at diagnosis, clinical staging, as well as the percentage of breast conservative surgery along this period of three decades. From 2,103 identified women, 1,607 women met our criteria for study entry and had follow‐up information, constituting our study cohort. Statistical tests were two‐sided and considered significant at p < 0.05. There was a decrease of about 0.8 cm in the median tumor diameter over this 30‐year period. The incidence of early‐stage tumors increased progressively over time, and the percentage of patients presenting with stage I breast cancer doubled in 30 years. The Halsted procedure that represented 11.5% of surgeries in the 1970s is a very rare procedure nowadays (<1% of cases). Modified radical mastectomy was the procedure applied in about 50% of women with invasive breast cancer during these 30 years of observation. Notably, breast conservative surgery increased from 17.3% in the 1970s to 43.2% in the 2000s, while the decrease in tumor size and clinical staging was accompanied by an increased number of breast conservative surgical procedures. In geographic areas where coordinated preventive efforts are not thoroughly available, analysis of subsets of the patient population using tumor size as a surrogate represents an indirect way to observe long‐term effects of prevention. The present study shows that tumor size is a surrogate for populations from developing countries too and gives scientific support for the design of continuous comprehensive programs of breast cancer prevention in this setting.

Immediate reconstruction with autologous fat grafting: influence in loco regional recurrence in breast cancer

Objective to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Colemans technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure..................................................................................................... 14 INTRODUÇÃO ................................................................................................ 16 REVISÃO DA LITERATURA ........................................................................... 19 1 Estratégias para localizar e selecionar as informações ............................ 19 1.1 Marco conceitual esquemático .......................................................... 20 2 Cirurgia conservadora .............................................................................. 20 3 Enxerto autólogo de gordura .................................................................... 25 3.1 Lipoenxertia ....................................................................................... 25 3.2 Biologia .............................................................................................. 25 3.3 Técnica .............................................................................................. 27 3.4 Conceito de enxerto estruturado de gordura de Coleman ................. 29 3.5 Indicações ......................................................................................... 33 3.6 Risco oncológico................................................................................ 34 3.7 Seguimento Radiologico .................................................................... 40 JUSTIFICATIVA .............................................................................................. 42 HIPÓTESES ................................................................................................... 43 OBJETIVOS .................................................................................................... 44 REFERÊNCIAS .............................................................................................. 45 ARTIGO EM INGLÊS...................................................................................... 53

Immediate reconstruction with autologous fat grafting: influence in breast cancerregional recurrence

Objective to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Colemans technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure..................................................................................................... 14 INTRODUÇÃO ................................................................................................ 16 REVISÃO DA LITERATURA ........................................................................... 19 1 Estratégias para localizar e selecionar as informações ............................ 19 1.1 Marco conceitual esquemático .......................................................... 20 2 Cirurgia conservadora .............................................................................. 20 3 Enxerto autólogo de gordura .................................................................... 25 3.1 Lipoenxertia ....................................................................................... 25 3.2 Biologia .............................................................................................. 25 3.3 Técnica .............................................................................................. 27 3.4 Conceito de enxerto estruturado de gordura de Coleman ................. 29 3.5 Indicações ......................................................................................... 33 3.6 Risco oncológico................................................................................ 34 3.7 Seguimento Radiologico .................................................................... 40 JUSTIFICATIVA .............................................................................................. 42 HIPÓTESES ................................................................................................... 43 OBJETIVOS .................................................................................................... 44 REFERÊNCIAS .............................................................................................. 45 ARTIGO EM INGLÊS...................................................................................... 53

Reconstrução imediata com enxerto autólogo de gordura : influência na recorrência local de câncer de mama

Objective to evaluate local and systemic recurrence of breast cancer in patients submitted to autologous fat grafting in the immediate reconstruction after conservative surgery for breast cancer. Methods this is a historical cohort study comparing 167 patients submitted to conservative surgery without reconstruction (conservative surgery group) with 27 patients submitted to conservative treatment with immediate graft reconstruction, following the Colemans technique (lipofilling group). All patients had invasive carcinoma and were operated by a single surgeon from 2004 to 2011. The postoperative follow-up time was 36 months. Results the overall incidence of local recurrence was 2.4%. No patient in the lipofilling group had local recurrence during the study period. For systemic recurrence, the rates obtained were 3.7% (one patient) for the fat grafting group and 1.8% (three patients) for the conservative surgery group without reconstruction. Conclusion there was no significant difference for local or systemic recurrence in the groups studied. Immediate autologous fat grafting appears to be a safe procedure..................................................................................................... 14 INTRODUÇÃO ................................................................................................ 16 REVISÃO DA LITERATURA ........................................................................... 19 1 Estratégias para localizar e selecionar as informações ............................ 19 1.1 Marco conceitual esquemático .......................................................... 20 2 Cirurgia conservadora .............................................................................. 20 3 Enxerto autólogo de gordura .................................................................... 25 3.1 Lipoenxertia ....................................................................................... 25 3.2 Biologia .............................................................................................. 25 3.3 Técnica .............................................................................................. 27 3.4 Conceito de enxerto estruturado de gordura de Coleman ................. 29 3.5 Indicações ......................................................................................... 33 3.6 Risco oncológico................................................................................ 34 3.7 Seguimento Radiologico .................................................................... 40 JUSTIFICATIVA .............................................................................................. 42 HIPÓTESES ................................................................................................... 43 OBJETIVOS .................................................................................................... 44 REFERÊNCIAS .............................................................................................. 45 ARTIGO EM INGLÊS...................................................................................... 53

Inframammary Fold Reconstruction

Creating a well-defined inframammary fold is very important for the success of breast reconstruction, regardless of the surgical technique used. Inframammary fold reconstruction is mainly performed in the case of late postmastectomy breast reconstruction. Several surgical techniques have been described for both creation and correction or better definition of the inframammary fold. These techniques may be used during primary breast reconstruction or later, when the tissue expander is replaced with flaps, implants, or both. We describe four techniques for reconstructing the inframammary fold—external approach, internal approach, anchor approach, and allograft approach—as secondary procedures after breast reconstruction.

Lipofiling Adds Diagnostic Difficulties in Imaging Evaluation After Radiotherapy? Case-Control Study

INTRODUCTION: Immediate autologous fat grafting has yet to be assessed as an alternative for breast reconstruction following conserving surgery. The present study sought to compare mammographically, patients undergoing conserving surgery with patients undergoing autologous adipose tissue immediately to conserving surgery, after completion of radiation. MATERIALS AND METHODS: This is a case-control study. The convenience sampling occurred between June 2010 and Dec 2011, where 28 patients coming from the outpatient Breast Care Unit with the indication of breast conserving surgery underwent breast reconstruction with fat grafting. Controls were consecutive cases, 60 patients, of conservative surgery that occurred in the same period. After the surgical procedure, all were subjected to radiotherapy. All patients underwent clinical and radiological evaluation at 6 months. RESULTS: The results of early evaluation in six months, showed no difference between the mammographic findings in patients undergoing conservative surgery and conventional surgical repair with fat grafting. CONCLUSION: Immediate autologous fat grafting is a promising technique for reconstruction after breast-conserving surgery. The evaluation performed by an observer who did not contain the information of the fat grafting technique has been shown that increased degree of harder it not for the diagnosis of changes in mammographic post surgery patients submitted to this technique. KEYWORDS: Autologous fat grafting; breast-conserving surgery; breast reconstruction; lipofilling; breast cancer.

Association of Axillarty Web Syndrome and Body Mass Index

INTRODUCTION: Breast cancer incidence has been increasing in Brazil and is now the leading cause of cancer death among women. Axillary web syndrome (AWS) is may occur in patients who underwent surgery for breast cancer with an axillary approach, either sentinel lymph node (SLN) biopsy or axillary dissection (AD). It usually appears 8 to 15 days after axillary surgery and is characterized by cords of subcutaneous tissue that extend from the axilla to the medial arm, sometimes reaching also the thumb. Few reports have been published describing this entity, that may cause pain and limitation of homolateral movements, especially shoulder abduction. Patients with a body mass index (BMI) greater than 25 seems to have a trend not to form cords, probably because cushions of fat may favor the reabsorption of lymph. MATERIALS AND METHODS: We evaluated patients with breast cancer treated in a referral center in Porto Alegre - RS from November 2010 to May 2012. Data from patients with the diagnosis of AWS were extracted from a large database. We compared shoulder range motion with BMI in these patients. RESULTS: We evaluated 54 patients with AWS. The mean age was 50. 7 years and the mean BMI was 23. 9kg/m2. Patients had stage IA to IIIC breast cancer. The web syndrome appeared to be a major cause of limitation in shoulder range of motion. Shoulder abduction was limited to 90 degrees or less in 21 (38%) of all the AWS patients. Mean BMI of patients who lost 50% or more of shoulder abduction was similar to those who lost less than 50% (23. 9kg/m2 versus 24. 3kg/m2 respectively). Mean BMI of patients who who lost 50% or more of shoulder flexion was similar to those who lost less than 50% (24. 9kg/m2 versus 23. 7kg/m2 respectively). DISCUSSION AND CONCLUSION: Axillary web syndrome is a definite clinical entity that tends to develop after axillary surgery for breast cancer. It is associated with pain and limitation of shoulder movement. We did not find any association between limitations in shoulder range motion according with BMI.