Wilson Cintra Junior

Post-bariatric thighplasty: result assessment

BACKGROUND: Patients who experience massive weight loss often require a thighplasty procedure to reduce excess skin and reshape thighs and lower body contour, improving movement, hygiene, posture, self-image, and quality of life. METHODS: After weight loss and stabilization of weight, eight patients in the postoperative period of gastric bypass were subjected to a thighplasty. Measurements of upper and lower circumferences of the thighplasty and thigh heights were obtained in the preoperative and postoperative periods of 60 and 180 days for comparison of volume change after the surgical procedure. RESULTS: The average volume reduction of each thigh at a postoperative period of 180 days was 1,135 cm3 or 1.135 liters. All patients had small areas of dehiscence along the scars on the medial thigh, and dressings were applied for healing by secondary intention. One (12.5%) patient had cysts in both thighs, confirmed by ultrasound, and required surgical intervention for resection and subsequent resolution. CONCLUSIONS: It was possible to demonstrate significant reduction in the volume of each thigh after plastic surgery for contour refitting. Patient satisfaction and complications associated with the procedures performed were also documented.

Augmentation mastopexy after bariatric surgery: evaluation of patient satisfaction and surgical results.

OBJECTIVE to evaluate patient satisfaction and surgical results obtained after mastopexy with breast implant inclusion. METHODS we conducted a prospective study of 20 consecutive female patients with a mean age of 39.9 years, submitted to augmentation mastopexy. We applied semi-directed psychological interviews pre and postoperatively. The answers to the evaluations were tabulated, categorized, and allowed patient satisfaction analysis. We evaluated surgical results through photographic analysis of three independent plastic surgeons, in the pre and postoperative periods, when scores were attributed to the following items: breasts shape, breasts volume, breasts symmetry, nipple-areolar complex position, and scar quality and extent. RESULTS nineteen patients (95%) referred satisfaction with the surgical results attained (p<0,001). The mean sum of the scores attributed by the three surgeons to each patient varied between 4.7 and 10, with an overall mean of 7.28. The results were considered good or great for 65% of the sample and poor for 8.4%. CONCLUSION there was a 95% satisfaction rate among patients with the results obtained through augmentation mastopexy. The photographic analysis of the results obtained a mean score of 7.28, considered as a good result, albeit the weak correlation among evaluators. OBJETIVO avaliar a satisfação das pacientes e os resultados cirúrgicos obtidos após a mastopexia com inclusão de implantes mamários. MÉTODOS estudo prospectivo com 20 pacientes consecutivas do sexo feminino, com média etária de 39,9 anos, que foram submetidas à mastopexia de aumento. Foram aplicadas entrevistas psicológicas semidirigidas nos períodos pré e pós-operatórios e cujas respostas foram tabuladas, divididas em categorias, e possibilitaram a avaliação da satisfação das pacientes. Foi realizada avaliação dos resultados cirúrgicos através da análise fotográfica por três cirurgiões plásticos independentes, nos períodos pré e pós-operatórios, que atribuíram notas aos seguintes itens: forma da mama, volume da mama, simetria entre as mamas, posicionamento do complexo aréolo-papilar e qualidade e extensão das cicatrizes. RESULTADOS dezenove pacientes (95%) referiram satisfação com o resultado cirúrgico obtido (p<0,001). A média das somatórias das notas atribuídas pelos três cirurgiões, referentes a cada paciente, variou entre 4,7 e 10, sendo a média geral de 7,28. Os resultados foram considerados bons ou ótimos para 65% da amostra e pobres para 8,4%. CONCLUSÃO houve satisfação de 95% das pacientes com os resultados obtidos pela mastopexia de aumento. A análise fotográfica dos resultados obteve nota média de 7,28, caracterizado como bom resultado, apesar da fraca concordância entre os avaliadores.

Brachioplasty after bariatric surgery: evaluation of patient satisfaction

Introduction: Upper limb deformity caused by massive weight loss can be corrected by brachioplasty. This plastic surgery improves limb contour, facilitates hygiene, and enables use of certain clothing. Objective: To present the cases, describe interventions and complications, and evaluate the satisfaction of patients who underwent brachioplasty after bariatric surgery. Method: Herein, 34 patients (including 33 females) aged 46.6 ± 12 years, who underwent brachioplasty after bariatric surgery, were recruited for the study. Interventions and complications associated with the surgical procedure were described, and the satisfaction of 33 patients was evaluated by a qualitative interview and specific questionnaire. Results: As a minor complication, slight dehiscence was observed in five patients (14.7%), but no major surgical com plications were seen. Some degree of satisfaction was reported by 81.8% of the patients, and the outcome achieved in 69.7% was close to that expected. Conclusions: The brachioplasty techniques that were used restored proper arm contour with a low rate of minor complications, and a high degree of satisfaction among the patients evaluated.

Cirurgias plásticas para readequação de contorno corporal de pacientes submetidos a cirurgia bariátrica durante a adolescência

INTRODUCAO: A partir da decada de 1990 foram iniciados os primeiros tratamentos cirurgicos da obesidade em adolescentes, seguindo a sequencia cirurgia bariatrica, perda ponderal e dismorfismo corporal, criando demanda por cirurgias plasticas para readequacao do contorno corporal. O objetivo deste estudo foi identificar fatores associados a cirurgias plasticas de readequacao de contorno corporal (morbidade e mortalidade), realizadas em pacientes submetidos a cirurgia bariatrica durante a adolescencia. METODO: Entre janeiro de 2008 e janeiro de 2011, 5 pacientes submetidos a gastroplastia redutora durante a adolescencia, com consequente perda e estabilizacao de peso, foram submetidos a cirurgias plasticas do contorno corporal. A media de idade no inicio das cirurgias plasticas foi de 19,7 anos, sendo 3 (60%) pacientes do sexo feminino. Foram realizadas dermolipectomias abdominais em todos (100%) os pacientes, dermolipectomias crurais em 4 (80%), dermolipectomias braquiais em 2 (40%), mamoplastia com inclusao de implantes de silicone em 2 (40%) pacientes do sexo feminino, mastopexia na terceira paciente do sexo feminino (20%) e correcao de ginecomastia em 1 (20%), toracoplastia em 2 (40%), torsoplastia em 2 (40%) e torsoplastia reversa em 1 (20%). Foram realizadas, em media, 3 intervencoes cirurgicas por paciente, sendo operados 20 sitios cirurgicos. RESULTADOS: Ocorreram deiscencias em 3 (15% dos sitios cirurgicos) casos e foi necessario revisar a resseccao dermogordurosa por flacidez residual em 3 (15% dos sitios cirurgicos) casos. CONCLUSOES: Foram identificados alguns fatores associados as cirurgias plasticas de readequacao de contorno corporal na amostra de 5 pacientes submetidos a cirurgia bariatrica durante a adolescencia, comparaveis aos da literatura especifica.

Tratamento das dismorfias coxofemorais em pacientes ex-obesos

Background: Patients showing massive weight loss eventually develop excessive skin and fat in several body parts, including the lower extremities. Given the diversity of the localization, shape, and content of coxofemoral dysmorphia, this study proposes guidelines for planning and systematizing the treatment of each deformity. Methods: Twenty-eight female patients who underwent thigh lifts and showed 3 types of deformities were assessed. The deformities encompassed the upper third of the thigh alone, the upper and middle thirds, or the entire medial aspect of the thighs. A specific technique was used for treating each type of deformity. Moreover, when necessary, suspension of the lateral thigh was combined with liposuction. Patient satisfaction with the surgical results was assessed by a graded questionnaire. Unexpected events, complications, and treatments were recorded. Results: Mobility, hygiene, sexual performance, use of clothing, and scars were assessed as excellent (80.5%), good (14.5%), and regular (5%). Conclusions: Considering the broad heterogeneity of thigh dysmorphia in formerly obese patients, therapeutic guidelines correlating each type of deformity with a specific treatment are necessary.

Tratamento cirúrgico da ginecomastia com pedículos lateral e medial

Gynecomastia is the growth of the male breast and it can appear in 65% of the patients between I3 and I6 years old. The most common causes are hepatitis or liver cirrosis, lung carcinoma or chronic inflammatory lung disease, testicular disfunction or carcinoma, endocrinologic tumors (pituitary or adrenal glands), alterations of the serum leves of testosterone, genetic syndromes (Klinefelter Syndrome, p.ex.), drug abuse (heroine, marijuana or anabolic steroids) and Hansen Disease. It can be classified according its volume, to the tissues that are enlarged (fat, glandular or both) or to the surgical treatment that is required (small, moderate or severe). The treatment of the larger forms of gynecomastia is very different from that of the less severe forms. In the larger forms, beside the need of ressection of the glandular and/or fat tissues, the surgeon may have to ressec redundant skin and reposition the nipple-areola complex. This paper describes a specific surgical technique for this situation, by using two flaps based on lateral and medial pedicles, with 2cm thickness, that maintain the nutrition of the flaps. The pedicles are limited by dividing the four quadrants of the gynecosmastia with 45 degrees lines, using the nipple as the central point. The epidermis of the redundant skin area seen by the pinch test is then ressected, and the two-layer suture is made. The final scar is periareolar. Twenty patients with severe forms of gynecomastia underwent this surgical procedure. The mean age of 23,3 years old, and six patients had dark skin. The good positioning of the nipple-areola complex and a periareolar scar were the goals. The complications were: assimetry of the nipple-areola complex in two cases, both having severe assimetry on the pre-operative evaluation; one patient with dark skin had a hypertrophic scar; that was treated with intra-lesional applications of triancinolone; partial necroses of the areola occurred in one case, which led to secondary healing with good results; one case of dehiscence of the periareolar suture was observed, which was sutured again, with no further problems. Additionally, four patients had hemato-serous fluid collection, that resolved completely after percutaneous drainage.