ABSTRACT Purpose: To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. Methods: This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. Results: Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, ‘Support,’ had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was ‘Qualification’ (9.94 ± 0.3), followed by ‘Result’ (9.86 ± 0.4). There was a positive correlation between ‘type of oncologic surgery’ and ‘intentions of loyalty to the service’ (ρ = 0.272; p = 0.009) and a negative correlation between ‘education’ and ‘quality of the environment’ (ρ = –0.218; p = 0.039). The higher the patient’s level of education, the higher the score attributed to ‘relationship’ (ρ = 0.261; p = 0.013) and the lower the score of ‘aesthetics and functionality’ (ρ = –0.237; p = 0.024). Conclusions: The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

ABSTRACT We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

RESUMO Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

SUMMARY OBJECTIVE: This study aimed to translate the BREAST-Q© — Breast Reconstruction Expectations Module (preoperative) 2.0 into Portuguese and adapt it to the Brazilian cultural context. METHODS: Authorization for translation and cross-cultural adaptation of the questionnaire was obtained from the holders of the instrument's distribution rights. The questionnaire was translated and retro-translated. For cultural adaptation, the instrument was applied to 40 patients who had breast reconstruction surgery scheduled. Cronbach's alpha was used to assess the internal consistency. RESULTS: The mean age of the patients was 53.5 years, and the majority (72.5%) was undergoing reconstruction with implants. Good and excellent internal consistencies were observed for the Coping and Appearance expectations scales (Cronbach's alpha values of 0.878 and 0.909, respectively). For the Pain scale, the internal consistency was moderate (0.738), and it was acceptable (0.587) for the Medical team. CONCLUSION: The BREAST-Q© — Breast Reconstruction Expectations Module (preoperative) 2.0 was successfully translated and adapted to the Brazilian context.

Summary OBJECTIVE: This study aimed to compare the publications authored by plastic surgeons with those from other specialties’ surgeons on patient-reported outcomes of oncoplastic surgery. METHODS: A review was carried out on the Medline database, emcompassing five years (2015-2020). Studies about partial breast reconstruction after conservative treatment, immediate or delayed, by any technique, which presented patient-reported outcomes, were included. RESULTS: We found 292 articles, from which 142 met the eligibility criteria. Publications were stratified into groups 1 (plastic surgeons) and 2 (other surgical specialties), and also into groups A (only plastic surgeons), B (only other specialties) and C (both), and compared statistically. Most publications (60.6%) were attributed to specialties other than plastic surgery. Nineteen percent had only plastic surgeons as authors, 50% only other specialties’ surgeons, and 31% had both. There was no difference between groups regarding the impact factor of the journals in any of the stratifications, and the majority was published in journals with impact factor ≤2. CONCLUSION: In the last years, surgeons from specialties other than plastic surgery published more about the results of the oncoplastic surgery reported by the patients. There was no statistical difference between the groups regarding the impact factor of the journals.

RESUMO Introdução: A mamoplastia é uma das cirurgias mais realizadas pelos cirurgiões plásticos. Como todo procedimento, não é isenta de riscos ou complicações. Objetivos: Discutir questões controversas e intercorrências em cirurgia mamária e principais tratamentos. Métodos: Participaram da discussão quatro membros titulares da SBCP com ampla experiência em cirurgia plástica mamária, além do regente do capítulo de mamoplastias. Foram avaliados fatores que apresentavam maior controvérsia em mamoplastias: utilização de antibióticos; infiltração pré-operatória; associação da mamoplastia com implantes mamários; grandes ptoses mamárias; mamoplastia masculinizadora; retalhos para ascensão do complexo areolopapilar (CAP); utilização de drenos; curativos em mamoplastias e enxerto de gordura. Resultados: A literatura e discussão entre especialistas gerou as observações: há evidencias robustas da efetividade no uso de antibióticos perioperatório de mamoplastias redutoras, mas não há evidências de benefícios em se manter o uso por mais de 24 horas; a infiltração pré- operatória com soluções vasoconstritoras não reduz a incidência de hematoma; em mamoplastia associada a implantes não houve consenso sobre a melhor técnica, plano ou textura do implante; não houve consenso sobre a melhor técnica na ascensão do CAP em grandes ptoses, se enxertos ou retalhos; a mamoplastia masculinizadora não apresenta complicações diversas das encontradas na literatura; não existe protocolo específico para conduta quando há sofrimento do CAP; curativos podem ser removidos no primeiro dia de pós-operatório ou mantidos por mais tempo, e deve haver parcimônia no enxerto de gordura. Conclusão: O presente estudo concluiu que a mamoplastia é uma cirurgia segura, porém são necessários estudos continuados que possibilitem minimizar complicações.

ABSTRACT Introduction: Mammoplasty is one of the most performed surgeries by plastic surgeons. Like every procedure, it is not free of risks or complications. Objectives: Discuss controversial issues and complications in breast surgery and main treatments. Methods: Four full members of the SBCP with extensive experience in breast plastic surgery participated in the discussion, in addition to the regent of the mammoplasty chapter. Factors that presented the greatest controversy in mammoplasties were evaluated: use of antibiotics; preoperative infiltration; association of mammoplasty with breast implants; large mammary ptoses; masculinizing mammoplasty; flaps for the elevation of the nipple-areola complex (NAC); use of drains; dressings in mammoplasties and fat grafting. Results: The literature and discussion among specialists generated the observations: there is robust evidence of the effectiveness in the use of perioperative antibiotics of reducing mammoplasties, but there is no evidence of benefits in maintaining use for more than 24 hours; preoperative infiltration with vasoconstrictor solutions does not reduce the incidence of hematoma; in mammoplasty associated with implants there was no consensus on the best technique, plane or texture of the implant; there was no consensus on the best technique in the elevation of NAC in large ptoses, whether grafts or flaps; masculinizing mammoplasty does not present complications different from those found in the literature; there is no specific protocol for conduct when there is suffering from the NAC; dressings can be removed on the first postoperative day or kept longer, and there should be parsimony in the fat graft. Conclusion: The present study concluded that mammoplasty is safe surgery, but continued studies are needed to minimize complications.

RESUMO Objetivo: comparar o uso de solução alcoólica de clorexidina 0,5% e de álcool 70% na antissepsia da pele para bloqueios do neuroeixo. Método: ensaio clínico randomizado de não inferioridade, com dois braços paralelos. Foram selecionados 70 pacientes candidatos à bloqueio do neuroeixo, randomicamente alocados para o grupo A (n=35), em que a antissepsia foi realizada com clorexidina alcoólica 0,5%, ou para o grupo B (n=35), em que se utilizou álcool etílico hidratado 70%. Foram coletadas, com swab, amostras para cultura em três momentos: antes da antissepsia, dois minutos após aplicação do antisséptico, e imediatamente após a punção. As amostras foram semeadas em três meios de cultura e foi contabilizado o número de unidades formadoras de colônias (UFC) por cm². Resultados: não houve diferença entre os grupos quanto à idade, ao sexo, ao índice de massa corporal, ao tempo para realização do bloqueio ou tipo de bloqueio. Também não houve diferenças entre os grupos na contagem de UFC/cm² antes da antissepsia. Constatou-se menor crescimento bacteriano no grupo B dois minutos após aplicação do antisséptico (p=0,048), mas não houve diferença entre os grupos quanto ao número de UFC/cm² ao final da punção. Conclusão: o álcool 70% mostrou-se mais efetivo em reduzir o número de UFC/cm² após dois minutos, e não houve diferença entre os dois grupos quanto à colonização da pele ao final do procedimento. Esses resultados sugerem que o álcool 70% pode ser opção para antissepsia da pele antes de bloqueios do neuroeixo. Registro ensaio clínico: ClinicalTrials.gov, NCT02833376.

ABSTRACT Objective: to compare the use of 0.5% alcoholic chlorhexidine and 70% alcohol in skin antisepsis for neuraxial blocks. Method: this is a non-inferiority randomized clinical trial, with two parallel arms. Seventy patients who were candidates for neuraxial block were randomly allocated to group A (n = 35), in whom antisepsis was performed with 0.5% alcoholic chlorhexidine, or to group B (n = 35), in whom we used 70% hydrated ethyl alcohol. Swabs were harvested for culture at three times: before antisepsis, two minutes after application of the antiseptic, and immediately after puncture. The samples were sown in three culture media and the number of colony forming units (CFU) per cm² was counted. Results: there was no difference between the groups regarding age, sex, body mass index, time to perform the block or type of block. There were no differences between groups in the CFU/cm² counts before antisepsis. There was less bacterial growth in group B two minutes after application of the antiseptic (p = 0.048), but there was no difference between the groups regarding the number of CFU/cm² at the end of the puncture. Conclusion: 70% alcohol was more effective in reducing the number of CFU/cm² after two minutes, and there was no difference between the two groups regarding skin colonization at the end of the procedure. These results suggest that 70% alcohol may be an option for skin antisepsis before neuraxial blocks. Trial registration: ClinicalTrials.gov, NCT02833376.

RESUMO Objetivos: A pulpotomia em dentes decíduos mantém a integridade e a saúde dos dentes decíduos e dos tecidos de suporte, até a erupção de um dente permanente. O cimento PBS HD CIMMO® foi avaliado em pulpotomias de dentes decíduos como material de base e restauração. Um ensaio clínico randomizado foi realizado. Métodos: Este estudo foi aprovado pelo Comitê de Ética da Universidade Vale do Sapucaí, UNIVÁS, com Certificado de Apresentação para Consideração Ética, número do protocolo: 1.771.929. Foram selecionados 60 dentes molares decíduos de 32 crianças saudáveis. Esses dentes foram divididos em dois grupos: G1 com 30 dentes, no qual foi utilizado o tratamento clássico com formocresol e G2 com 30 dentes, no qual o cimento PBS HD CIMMO® foi utilizado como base e restauração final simultânea. A avaliação foi realizada 12 meses após a intervenção através de exames clínicos e radiográficos. O teste exato de Fisher foi utilizado para correlacionar os aspectos clínicos e radiográficos nos dois grupos. Resultados: Não houve diferença significativa (p = 0,090) na avaliação clínico-radiográfica. O cimento PBS HD CIMMO® é uma opção para ser usado como um elemento único em pulpotomias de dentes decíduos. Conclusão: Estudos longitudinais devem ser realizados para demonstrar uma associação significativa entre esses grupos. O estudo foi inscrito em ensaios clínicos (Clinical Trials.gov) com o registro NCT03200938.

ABSTRACT Objective: Pulpotomy in deciduous teeth maintains the integrity and health of deciduous teeth and supporting tissues until a permanent tooth has erupted. PBS HD CIMMO® cement was evaluated in deciduous teeth pulpotomies as base material and restoration. A randomized clinical trial was performed Methods: This study was approved by the Ethics Committee of (Universidade Vale do Sapucaí) UNIVÁS with Certificate of Presentation for Ethical Consideration, protocol number is: 1.771.929. 60 deciduous molar teeth from 32 healthy children were selected. These teeth were divided into two groups: G1 with 30 teeth, in which the classictreatment with formocresol was used, and G2 with 30 teeth, in which PBS HD CIMMO® cement was used as base and simultaneous final restoration. The evaluation was performed 12 months after the intervention through clinical and radiographic exams. Fisher’s exact test was performed to correlate the clinical and radiographic aspects in both groups Results: There was no significant difference (p= 0.090) in the clinical-radiographic evaluation. PBS HD CIMMO® cement is option to be used as a single element in pulpotomies of deciduous teeth Conclusion: Longitudinal studies should be performed in order to demonstrate a significant association between these groups. The study was enrolled in clinical trials (clinical trials.gov) with registration NCT03200938.

OBJECTIVES: This study aimed to culturally validate the FACE-Q - Satisfaction with Facial Appearance Overall Scale (Face-Q SFAOS) in a population of Brazilian rhytidoplasty patients. METHOD: Authorization for the translation and validation of the questionnaire was obtained from the FACE-Q SFAOS distribution rights holders. The FACE-Q SFAOS was translated and then back-translated. For cultural validation, a total of 57 women were selected 5 to 8 months after undergoing rhytidoplasty. Twenty of them participated in the cultural adaptation, 30 participated in the reproducibility analysis, and 57 participated in the construct validation. RESULTS: The analysis identified two factors (general appearance and face geometry) that exhibited excellent internal consistency. The total satisfaction score, which comprised nine items, also presented excellent internal consistency. Good reproducibility was found for Overall Appearance, Geometry and Total. There was a difference in the satisfaction means (total and factors) between procedure locations; patients undergoing frontal, upper eyelid and lower eyelid procedures were less satisfied than those who did not undergo such procedures. Satisfaction was higher with geometry than with overall face appearance. CONCLUSION: The FACE-Q SFAOS was adapted to the cultural context of Brazilian rhytidoplasty patients and was reproducible, and the scale exhibited face, content and construct validity.

Abstract Purpose To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil. Methods This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI. Results Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups. Conclusion Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.

Abstract Purpose To evaluate PBS®MCIMMO cement in the filling of bone defects. Methods Thirty-six adult male Wistar rats were divided into three groups of twelve individuals each (group 1, group 2 and group 3). In all groups, a bone failure in the femur was induced, 2.0 mm wide and 7.0 mm deep. In group 1, the PBS®MCIMMO cement was applied to the bone defect produced and a titanium implant (CONNECTION®) 1.5 mm thick and 6 mm long was installed. In group 2, only the PBS® CIMMO cement was installed. In group 3, only bone failure was performed. Kruskal Wallis tests were performed to compare the mean area among the three groups. Results In all comparisons, significance was observed for group 2 (p = 0.0014–0.0026). Conclusion The PBS®CIMMO cement induced bone neoformation, and integration between the newly formed bone, cement, and implant was observed.

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.

OBJECTIVE: To assess work ability and productivity in patients with diabetic foot. METHODS: This investigation was a cross-sectional controlled study. A total of 117 individuals were selected from March to June 2014 and allocated to group A (patients without diabetes, n=43), group B (diabetes patients without foot ulcers, n=43), or group C (patients with diabetic foot, n=31). Two validated instruments, the Work Limitations Questionnaire (WLQ) and the Work Productivity and Activity Impairment Questionnaire General Health v2.0 (WPAI-GH), were used to assess work ability and productivity. RESULTS: The groups were homogeneous regarding age and sex; however, patients in group C had a lower education level than the other participants (p=0.006). The median WLQ scores for groups A, B, and C were 0.0121, 0.0146, and 0.0852, respectively (p<0.0001). The WPAI-GH scores revealed a mean productivity loss of 20% for groups A and B and 100% for group C (p<0.0001). CONCLUSIONS: Patients with diabetic foot showed decreased work ability and productivity.

▪ ABSTRACT Introduction: In two previous studies, the quality of randomized clinical trials (RCTs) with the participation of at least one plastic surgeon was assessed in two periods: from 1966 to 2003 and from 2004 to 2008. The objective is to evaluate the evolution of the quality of RCTs published by plastic surgeons in the subsequent five-year period, from 2009 to 2013. Methods: RCTs published from 2009 to 2013, in English, with the participation of at least one plastic surgeon, were identified by an electronic search and classified according to allocation concealment by two independent evaluators. The quality of the studies with adequate allocation concealment was evaluated by two evaluators using the Delphi List and the Jadad Scale. Results: Of the 6,997 identified studies, 261 were classified according to allocation concealment. Of these, 43 (16.47%) had adequate allocation concealment. According to an assessment conducted using the Delphi List, there was an improvement in the items “most important characteristics of the prognosis” (p < 0.001), “use of an independent evaluator” (p = 0.0029), and “measures of variability and estimation of points for the primary variable” (p = 0.0057) compared to the 1966-2003 assessment ; there was no difference in the assessment of the same items from 2004-2008. Regarding the Jadad Scale, there was an increase in the scores from 2009 to 2013 compared to the 1996-2003 period (p < 0.0004); however, there was no significant difference in the 2004-2008 period. Conclusion: There was no difference in the quality of the RCTs published by plastic surgeons in the 2009-2013 period compared to the previous five-year period (2004 to 2008). However, both periods indicated higher quality compared to the 1966-2003 period.

▪ RESUMO Introdução: Em dois estudos prévios, avaliou-se a qualidade dos ensaios clínicos aleatórios (ECAs) com a participação de pelo menos um cirurgião plástico, em dois períodos: 1966 a 2003 e 2004 a 2008. O objetivo é avaliar a evolução da qualidade das publicações de ECAs por cirurgiões plásticos no período subsequente de cinco anos, de 2009 a 2013. Métodos: ECAs publicados de 2009 a 2013, em língua inglesa, com a participação de pelo menos um cirurgião plástico, foram identificados por busca eletrônica e classificados quanto ao sigilo de alocação, por dois avaliadores independentes. Os estudos com sigilo de alocação adequado tiveram a qualidade avaliada por dois avaliadores, utilizando-se a Lista de Delphi e a Escala de Qualidade de Jadad. Resultados: Dos 6.997 estudos identificados, 261 foram classificados quanto ao sigilo de alocação. Destes, 43 (16,47%) tinham sigilo de alocação adequado. Segundo a avaliação pela Lista de Delphi, houve melhora, em relação a 1966-2003, nos itens “características mais importantes do prognóstico” (p < 0,001), “uso de avaliador independente” (p = 0,0029) e “medidas de variabilidade e estimativa de pontos para a variável primária” (p = 0,0057); não houve diferença em relação a 2004-2008. Quanto à Escala de Qualidade de Jadad, houve um aumento dos escores em relação a 1996-2003 (p < 0,0004), mas também sem diferença significante em relação ao período 2004-2008. Conclusão: Não houve diferença na qualidade das publicações de ECAs por cirurgiões plásticos no período de 2009 a 2013, em relação aos cinco anos anteriores (2004 a 2008). Entretanto, ambos os períodos apresentaram maior qualidade quando comparados ao período de 1966 a 2003.

ABSTRACT BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients’ quality of life. Our goal here was to compare patients’ satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.

OBJECTIVE: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.