■ ABSTRACT Introduction: Breast reconstruction after surgical treatment for breast cancer (one of the main cancers that affect women) has been progressively more recommended, given the benefits of psychological recovery and quality of life, whether using implants and/or autologous tissues. The present work aims to demonstrate the team’s experience, and discuss operative techniques and complications concerning data from the world literature, in addition to verifying the applicability of the technique in the team’s clinical practice. Method: Retrospective observational study developed at a university hospital in Juiz de Fora based on a review of medical records of patients who underwent mastectomy with breast reconstruction between 2010 and 2020. Results: Of the 860 breasts treated, 84% underwent immediate oncological surgery and 16% were late; the main access to the breast tissue was the Stewart incision, followed by extended inframammary, periareolar, and inverted T incisions; regarding reconstructive techniques, 35% of cases used a latissimus dorsi muscle flap, 25% used a prepectoral prosthesis, 20% used a transverse rectus abdominis myocutaneous flap and 10% used a local muscle flap. The most common complications were surgical site dehiscence, followed by skin necrosis, seroma, surgical site infection, and hematoma, in addition to other less common complications such as chronic pain and prosthesis rupture after mammography. Conclusion: Post-mastectomy breast reconstruction is essential for a woman’s physical and emotional recovery, with the techniques used in the last ten years being consistent, reliable, with low morbidity, and with excellent aesthetic results when correctly indicated. Introduction one women recommended life andor or tissues teams team s experience literature practice Method 201 2020 Results 86 treated 84 16 late incision inframammary periareolar incisions 35 25 20 10 dehiscence necrosis seroma infection hematoma mammography Conclusion Postmastectomy Post womans woman consistent reliable morbidity indicated 202 8 1 3 2

■ RESUMO Introdução: A reconstrução mamária pós-tratamento cirúrgico do câncer de mama (um dos principais cânceres que acometem as mulheres) tem sido progressivamente mais indicada, haja vista o benefício da recuperação psicológica e da qualidade de vida, seja utilizando implantes e/ou tecidos autólogos. O presente trabalho visa demonstrar a experiência da equipe, discutir técnicas operatórias e complicações em relação aos dados da literatura mundial, além de verificar a aplicabilidade da técnica na prática clínica da equipe. Método: Estudo observacional retrospectivo desenvolvido em hospital universitário em Juiz de Fora a partir da revisão de prontuários de pacientes submetidas a mastectomia com reconstrução mamária entre 2010 e 2020. Resultados: Das 860 mamas abordadas, 84% foram imediatas à cirurgia oncológica e 16% foram tardias; o principal acesso ao tecido mamário foi a incisão de Stewart, seguido de incisões inframamárias estendidas, periareolares e T invertido; quanto às técnicas reconstrutoras, destaca-se 35% dos casos com retalho com músculo grande dorsal, 25% com prótese pré-peitoral, 20% com retalho miocutâneo transverso do músculo reto abdominal e 10% com retalho muscular local. As complicações mais incidentes foram deiscência de sítio cirúrgico, seguida de necrose cutânea, seroma, infecção de sítio cirúrgico e hematoma, além de outros menos comuns como dor crônica e ruptura de prótese após mamografia. Conclusão: A reconstrução mamária pós-mastectomia é indispensável para a recuperação física e emocional da mulher, sendo as técnicas utilizadas nos últimos dez anos consistentes, confiáveis, de baixa morbidade e com ótimos resultados estéticos quando bem indicadas. Introdução póstratamento pós tratamento um mulheres indicada vida eou ou autólogos equipe mundial Método 201 2020 Resultados 86 abordadas 84 16 tardias Stewart estendidas invertido reconstrutoras destacase destaca se 35 dorsal 25 prépeitoral, prépeitoral pré peitoral, peitoral pré-peitoral 20 10 local cutânea seroma hematoma mamografia Conclusão pósmastectomia mulher consistentes confiáveis indicadas 202 8 1 3 2

Abstract Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings. Introduction (TPS Childrens Children s Hospital country Methods authors Subsequently 1030 030 1,03 201 2020 5 excluded or RACHS1. RACHS1 RACHS . RACHS-1) covariates Results 22 2. interquartile IQR [IQR 0.513 0513 0.5 13 0 0.5-13 108 10 8 10. 5.640 5640 5.6 40 6 5.6-40 kilograms respectively Inhospital In 658 6.58 n=64, n64 n n=64 , 64 (n=64) 197 19 7 19.7 n=192 n192 192 (n=192 35 37%, 37 37% (37%) 46 47.7%, 477 47.7% 47 (47.7%) 14 15.3%. 153 15.3% 15 (15.3%) coefficient (coefficient 6.6 66 error P=0.003, P0003 P P=0.003 003 P=0.003) odds OR [OR] 1.84 184 84 95 CI [CI] 1.13 113 1.1 1.1-3 P=0.01, P001 P=0.01 01 P=0.01) (OR 3.2 32 1.47 147 1.4 4 1.4-7 P=0.004. P0004 P=0.004 004 P=0.004) Conclusion rate highvolume high volume LatinAmerican Latin American program settings 103 03 1,0 20 202 RACHS-1 513 0.51 051 05 0. 0.5-1 640 5.64 564 56 5. 5.6-4 65 6.5 n6 n=6 (n=64 19. n=19 n19 (n=19 (37% 47.7 (47.7% 15.3 (15.3% 6. P000 P=0.00 00 [OR 1.8 18 9 [CI 11 1. 1.1- P00 P=0.0 3. 1.4- 1, RACHS- 51 0.5- 5.6- n= (n=6 n=1 n1 (n=1 (37 47. (47.7 15. (15.3 P0 P=0. (n= (3 (47. (15. P=0 (n ( (47 (15 P= (4 (1

ABSTRACT Introduction: Breast reconstruction plays an important role in the treatment of breast cancer. Several options are available for autologous breast reconstruction, the more widespread being the transverse rectus abdominis myocutaneous (TRAM) flap, the latissimus dorsi myocutaneous (LDM) flap, and the local muscle (LM) flap. The objective of this work was to demonstrate the initial experience in breast reconstruction with autologous tissue, with or without implants. Method: A retrospective analysis was performed of medical charts of 367 patients who underwent immediate and delayed breast reconstruction with the unipediculated TRAM flap, LD flap, or LM flap. Results: Three hundred eighty breasts were reconstructed. There were 156 TRAM flap procedures, 179 LD flap procedures, and 49 other techniques. The size of the implants ranged between 155 cc and 640 cc. The mean age of the patients was 49.33 years. One hundred ninety-seven patients underwent surgery on the right side and 169 on the left; 14 patients underwent bilateral reconstruction. Reconstruction was immediate in 80% of the patients. There were few moderate (partial dehiscence of the wound requiring suturing) and severe complications (flap liponecrosis, extrusion of the implant after infection, and pulmonary thromboembolism) and some minor complications that did not require surgical correction. Conclusions: Breast reconstruction with autologous tissue provides the plastic surgeon with a consistent and reliable method of breast reconstruction, with very satisfactory aesthetic results and low morbidity in selected patients. Introduction cancer (TRAM LDM (LDM (LM Method 36 Results reconstructed 15 procedures 17 4 techniques 64 4933 33 49.3 years ninetyseven ninety seven 16 left 1 80 partial suturing liponecrosis infection thromboembolism correction Conclusions 3 6 493 49. 8

RESUMO Introdução: A reconstrução mamária desempenha papel importante no tratamento do câncer de mama. Várias opções estão disponíveis para a reconstrução autóloga, sendo as mais difundidas o retalho do reto abdominal (TRAM), o retalho de grande dorsal e retalho muscular local. O trabalho visa demonstrar a experiência inicial na reconstrução mamária com tecido autólogo, acrescido ou não de implante. Método: Foi realizada análise retrospectiva de prontuários de 367 pacientes que foram submetidas à reconstrução mamária imediata e tardia com retalho do reto abdominal (TRAM) unipediculado ou retalho de grande dorsal (GD) ou retalho muscular local (RL). Resultados: Foram reconstruídas 380 mamas. Em 156 pacientes, a técnica foi TRAM; em 179, GD; e, em 49 pacientes, outras técnicas foram empregadas. O tamanho dos implantes variou entre 155 cc e 640 cc. A idade média das pacientes foi de 49,33 anos. 197 pacientes foram operadas do lado direito, 169 do lado esquerdo e em 14 pacientes a reconstrução foi bilateral. A reconstrução foi imediata em 80% das pacientes. Houve poucas complicações moderadas (deiscência parcial da sutura, com necessidade de ressutura) e graves (liponecrose do retalho, extrusão do implante após infecção e tromboembolismo pulmonar) e, ainda, algumas complicações menores que não demandaram correção cirúrgica. Conclusões: A reconstrução mamária com tecido autólogo fornece ao cirurgião plástico um método consistente e confiável de reconstrução mamária, com resultados estéticos muito satisfatórios e com morbidade pequena para pacientes selecionadas. Introdução mama autóloga TRAM, TRAM , Método 36 (TRAM GD (GD RL. RL . (RL) Resultados 38 mamas 15 179 4 empregadas 64 4933 33 49,3 anos 19 direito 16 1 bilateral 80 deiscência sutura ressutura liponecrose pulmonar ainda cirúrgica Conclusões selecionadas 3 (RL 17 6 493 49, 8