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The breast implant procedure is one of the most performed into Plastic Surgery and the contracture that occurs the capsule formed around the breast implants one of most frequent complication. We describe here one experimental model of capsule contracture in rats.

Introduction: The breasts are symbols of femininity, sexuality, and maternity. Breast augmentation is among the most sought-after procedures for women and has a positive impact on quality of life. Sexuality is one of the items that contribute to increased quality of life. Surgical outcomes can be evaluated from the patients' perspective using developed and validated questionnaires. For the assessment of sexuality, the most commonly used instruments are the Female Sexual Quotient and the Female Sexual Function Index, which estimate several domains of sexuality and can be used to evaluate the impact of surgery on it., Objective: The objective of this study was to evaluate the impact of breast augmentation on female sexuality., Methods: We selected 87 patients from the Plastic Surgery Outpatient Clinic of Hospital São Paulo (Federal University of São Paulo) who wished to undergo breast augmentation. The patients were classified into two groups: the Female Sexual Quotient questionnaire was applied to one group, and the Female Sexual Function Index questionnaire was applied to the other group to evaluate sexuality preoperatively as well as at 2 and 4 months postoperatively., Results: In both groups, there was a significant increase in the total score of the Female Sexual Quotient and Female Sexual Function Index questionnaires, and an individual increase in each domain assessed, with a significant increase in the domains of orgasm and sexual satisfaction, as well as foreplay and arousal, indicating an improvement in the patients' sexuality postoperatively., Conclusion: Breast augmentation has a positive impact on female sexuality; furthermore, the Female Sexual Quotient and Female Sexual Function Index are sensitive in detecting this impact.

Background: Fat grafting is used in combination with mammoplasty to improve filling of the upper pole of the breasts. Its effectiveness remains in question due to unpredictable results. Difficulty in isolating the grafted fat and differentiating it from host tissues may hinder assessment of graft integration. The plane between the pectoral muscles is free of fat and has already been described with respect to placement of breast implants and fat grafting in breast surgeries. This study sought to evaluate via magnetic resonance imaging (MRI) the integration and retention of retropectoral fat grafts in mammoplasty., Methods: Thirty patients with breast flaccidity who desired to undergo mammoplasty were selected. Fat collected from the abdomen was separated by sedimentation and transferred to the retropectoral region after undermining of the breast and resection of excess tissue. The patients underwent MRI preoperatively and at three and six months after surgery. Fat volumes were calculated by multiplying the values for the major vertical, horizontal, and anteroposterior axes by the constant 0.523., Results: Twenty-five patients completed the study. The mean volume grafted was 116.4 ± 22.5 ml per breast. Six months after surgery, the mean fat graft volume in the retropectoral plane was 48.1 ± 25.71 ml, and the integration rate was 40.82% (range, 32.2-49.4%). The rate of complications related to fat grafting was 8%., Conclusions: In mammoplasty, retropectoral fat grafting showed good integration rates and is a safe and predictable approach that can contribute to improving the outcomes of aesthetic and reconstructive breast surgeries., Level of Evidence Iv, Cohort Analytic Study: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Although there is limited evidence for regulating the use of prophylactic antibiotics in reduction mammaplasty, many plastic surgeons prescribe them, even in the postoperative period. This study aimed to conduct a national survey to investigate the antibiotic prophylaxis protocols followed by Brazilian plastic surgeons in reduction mammaplasty., Methods: An anonymous survey comprising 19 questions was sent to all 4864 active members of the Brazilian Society of Plastic Surgery (SBCP). The surgeons electronically received the invitation to participate in the survey and the link to fill out the electronic form., Results: In total, 859 surgeons (17.7%) responded. Most respondents (77.8%) were men and aged 35-55 years (61.5%); 58.6% of them had 10-29 years of specialty training. Only a minor proportion of the respondents (0.5%) reported not prescribing antibiotics at any time (95% confidence interval [CI]: 0.0-0.9), 9.9% (95% CI: 7.9-11.9) prescribed them only preoperatively, and 14.6% (95% CI: 12.2-16.9) prescribed continued antibiotic use for 24 h. The majority of the respondents (75.1%; 95% CI: 72.1-77.9) prescribed antibiotics for additional days after discharge. There were significant associations between antibiotic prescription and the surgeons' age group (p = 0.015), time since graduation (p < 0.001), experience in the specialty practice (p = 0.003), SBCP membership (p < 0.001), and surgical site infection rates (p = 0.011)., Conclusion: Most responding plastic surgeons affirmed that they prescribed prophylactic antibiotics for more than 24 h in reduction mammaplasty cases., Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 ., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background  Breast augmentation with implants is the most commonly performed cosmetic plastic surgery in Brazil and worldwide. The aim of this study was to assess patient satisfaction and quality of life following subpectoral breast augmentation with either microtextured or macrotextured implants, using the BREAST-Q. Methods  A prospective study was conducted with 40 women with hypomastia undergoing subpectoral breast augmentation. The patients were randomly allocated to two groups to receive either microtextured or macrotextured breast implants. All participants were assessed preoperatively (baseline) and after 2 and 4 months of surgery for quality of life and patient satisfaction with the surgical results, using the BREAST-Q augmentation module, a patient-reported outcome measure. Results  The patients had a mean age of 28.9 ± 6.45 years. The microtextured ( n  = 20) and macrotextured ( n  = 20) groups were homogeneous for sex, age, education level, marital status, and number of children ( p  > 0.05). Both groups showed significant improvement in satisfaction with breasts ( p  < 0.001), psychosocial well-being ( p  < 0.001), and sexual well-being ( p  < 0.001) at the 2- and 4-month follow-up visits compared with baseline. The observed improvements were associated with high effect size values of 5.09, 3.44, and 3.90, respectively. In contrast, significant decreases from baseline in physical well-being scores ( p  = 0.001) were found 2 and 4 weeks after surgery in both groups. Conclusion  Subpectoral breast augmentation with either microtextured or macrotextured breast implants improved satisfaction with breasts and quality of life in patients with hypomastia., Competing Interests: Conflict of Interest None declared., (The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

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.

Purpose: To compare JPEG and RAW image file extensions to direct measurement of the breast region., Methods: Points were marked on the breasts and arms of 40 female volunteers. The joining of these points in each hemibody formed seven linear segments, one angular segment and one median segment common to both hemibodies. Volunteers were photographed in a standardized fashion and evaluated by three raters using the software Adobe Photoshop CS6® and three image file extensions (RAW, high resolution JPEG and low resolution JPEG); values were compared to direct anthropometry., Results: All variables had interclass correlation coefficient higher than 0.8 (ICC>0.8). On average, all variables in all methods showed differences (p<0.05) when compared to direct measurement. A formula was created for each segment and each image file extension in comparison with the direct measurement., Conclusion: Measurements were similar among the correlated JPEG and RAW image file extensions but differed from the actual breast measurement obtained with a caliper.

Background: Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty., Methods: The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted., Results: There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003)., Conclusion: The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection., Clinical Question/level of Evidence: Therapeutic, I.

Background: Rhinoplasty is one of the most sought-after procedures in plastic surgery by individuals with body dysmorphic disorder (BDD). The identification of BDD symptoms is a challenge for plastic surgeons. The purpose of this study was to use a specific instrument for detection of BDD symptoms as a screening tool in rhinoplasty candidates and estimate the prevalence and severity of BDD symptoms in this population., Methods: Eighty patients of both sexes seeking rhinoplasty were consecutively recruited at a plastic surgery outpatient clinic of a university hospital from February 2014 to March 2015. In a clinical interview, 50 of them showed an excessive preoccupation with physical appearance associated with clinically significant subjective distress and were, therefore, selected to participate in the study. All participants were assessed using the Brazilian-Portuguese versions of the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) and the Body Dysmorphic Symptoms Scale (BDSS), which can be applied by plastic surgeons, who are laypersons in psychology/psychiatry., Results: Twenty-four (48%, 24/50) candidates had BDD symptoms, and 27 (54%, 27/50) showed moderate to severe appearance-related obsessive-compulsive symptoms. A strong correlation was found between the BDSS and BDD-YBOCS scores (r = 0.841, P < 0.001), and a strong agreement was observed between the BDSS cutoff point and body dysmorphic disorder symptom status (kappa = 0.822)., Conclusions: A high prevalence of BDD and moderate to severe appearance-related obsessive-compulsive symptoms was found among aesthetic rhinoplasty candidates. The BDSS may be used as a screening tool for BDD symptoms in plastic surgery patients., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Introduction: In two previous studies, the quality of randomized controlled trials (RCTs) with the participation of at least one plastic surgeon was evaluated in two periods: 1966-2003 and 2004-2008., Objective: To evaluate the evolution of the quality of RCT publications by plastic surgeons in the subsequent 5-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 electronic search and classified for concealment of allocation by two independent evaluators. The studies with adequate allocation concealment had their quality evaluated by two evaluators using the Delphi List and the Jadad Quality Scale., Results: Of the 6997 identified studies, 261 were classified as to concealment of allocation. Of these, 43 (16.47%) had adequate allocation concealment. According to the evaluation in the Delphi List, there was an improvement, in relation to 1966-2003, in the items "most important characteristics of the prognosis" (p < 0.001), "use of independent evaluator" (p = 0.0029), and "measures of variability and point estimate for the primary variable" (p = 0.0057); there was no difference in relation to 2004-2008. Regarding the Jadad Quality Scale, there was an increase in scores in relation to 1966-2003 (p < 0.0004) but not in relation to the 2004-2008 period., Conclusion: There was no difference in the quality of publications of RCTs by plastic surgeons in the period 2009-2013 compared to the previous 5 years (2004-2008), but both periods presented higher quality than the period 1966-2003., Level of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Background: One of the challenges in breast reduction is to maintain breast projection with 45% of its volume in the upper pole and 55% in the lower pole. Although widely used in breast surgeries, the behavior of fat grafts is still not completely understood., Objectives: To evaluate by magnetic resonance imaging (MRI) the survival of fat transferred to the retropectoral plane in patients undergoing breast reduction, in the search for an oncologically safe procedure with high predictability and reproducibility., Methods: This pilot study was conducted with 7 patients who underwent breast reduction combined with fat grafting in the submuscular plane. Aspirated fat was processed by sedimentation. MRI of the breasts was performed preoperatively and at 1 and 6 months postoperatively. Fat survival was calculated as the difference between the volumes of fat measured preoperatively and postoperatively by MRI divided by the volume of grafted fat., Results: Fourteen breasts were operated on and received on average 119.6 mL of autologous fat in the submuscular plane. Fat survival rate was 43.9% at 1 month after surgery, decreasing to 23.4% in the late postoperative period. The mean anteroposterior projection of the grafted tissue was 1.51 cm at 1 month postoperatively, decreasing to 1.07 cm in the late postoperative period., Conclusions: Retropectoral fat grafting may contribute to maintaining the fullness of the upper pole of the breasts. This is an innovative experimental model for future studies on fat harvesting, preparation, and grafting techniques, allowing the evaluation of fat graft survival., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

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 evaluate work ability and productivity in women who had undergone different types of surgical treatment for breast cancer, as well as breast reconstruction after mastectomy., Methods: This cross-sectional study assessed 152 women between 30 and 60 years of age, who worked outside the home in formal or informal jobs, or as self-employed. Thirty-eight of them had no history of breast cancer (control group), and 114 had undergone surgical treatment for breast cancer at least 1 year before their enrollment in the study, and were allocated as follows: mastectomy group (n = 38), breast-conserving surgery group (n = 38), or breast reconstruction breast reconstruction group (n = 38). The validated Brazilian versions of the Work Productivity and Activity Impairment-General Health questionnaire and Work Limitations Questionnaire were self-administered., Results: The groups were homogeneous regarding age, education level, and other sociodemographic characteristics. Patients in the mastectomy and breast-conserving surgery groups showed reduced work performance and productivity compared with women in the breast reconstruction and control groups (P = 0.0004 and P = 0.0006, respectively). In addition, women in the mastectomy group had more difficulty in performing activities of daily living compared with those in other groups (P = 0.0121)., Conclusions: Women who had undergone mastectomy or breast-conserving surgery had decreased work ability and productivity compared with women without a history of breast cancer and to those who had undergone breast reconstruction.

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.

Objective: The purpose of this study was to assess patient-reported outcomes of breast reconstruction with implants, using the BREAST-Q, in the late postoperative period., Materials and Methods: A total of 114 women previously operated due to breast cancer, in the late postoperative period (range 6-24 months) were enrolled in this cross-sectional study, and were allocated to either the mastectomy group (MG, n = 57) or reconstruction group (RG, n = 57). Patients in MG and RG, respectively, completed the Brazilian versions of Mastectomy and Reconstruction Modules of the BREAST-Q., Results: The mean age of patients was 46.6 and 44.3 years in MG and RG, respectively. All patients underwent chemotherapy and 6% and 11% of patients underwent radiotherapy in MG and RG, respectively. Patients in the RG reported higher satisfaction with surgical outcome (P < 0.0001). However, no significant between-group differences were found in physical and sexual well-being, or satisfaction with the plastic surgeon, medical team, and office staff., Conclusion: Breast reconstruction with implants increased patient satisfaction with the surgical outcome, but did not influence patients' physical and sexual well-being or their satisfaction with the treatment received., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The role of antibiotics in surgical procedures where the risk of surgical site infection (SSI) is low remains uncertain. There is, to date, no evidence to justify the routine use of antibiotics in postoperative reduction mammaplasty. The aim of this study is to evaluate the effect of postoperative antibiotic treatment on the occurrence of SSI after breast reduction surgery., Methods: This is a double-blind randomized clinical trial with 124 breast hypertrophy patients allocated to two treatment groups: antibiotic (n = 62) and placebo (n = 62). All patients will undergo reduction mammoplasty, performed by the same surgical team. The surgeons will raise the nipple-areola complex by the superomedial pedicle technique. The patients will receive antibiotics intravenously during anesthetic induction and every 6 hours thereafter during their 24-hour hospital stay. During discharge from the hospital, each patient will receive a numbered package containing either cephalexin or placebo capsules and will be directed to take one capsule every 6 hours for 7 days. Neither the surgery team nor the patients will know the contents of the capsules. Patients will be monitored for the occurrence of SSI once weekly during the first 30 days following hospital discharge by a single surgeon who is blinded to their treatment group. SSI will be evaluated based on the definition adopted by the Centers for Disease Control and Prevention., Discussion: Due to the variety of risk factors for SSI and limited case studies, conclusions regarding the effect of antibiotics on the occurrence of SSIs following reduction mammaplasty are potentially biased. In recent studies, perioperative antibiotic prophylaxis was effective in preventing infection and is therefore recommended in clinical practice. However, antibiotic use in the postoperative period still remains controversial., Trial Registration: Clinicaltrials.gov Identifier: NCT02569866 . Registered on 4 October 2015.

Background: The aim of the present study was to conduct a cross-cultural adaptation (with translation into Brazilian Portuguese) and validation of the European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire-Bone Metastases-22 (EORTC QLQ-BM22)., Methods: Ninety-five bone metastasis patients (31 men and 64 women, mean age 58.36±8.90 years) took part in the investigation. The translation guide of the EORTC was used to translate from English into Brazilian Portuguese and adapt the instrument culturally. The reliability and the face, content and construct validities were tested., Results: Internal consistency was estimated using Cronbach's alpha for the total score, pain and functional subscales of the EORTC QLQ-BM22 (0.93, 0.86, 0.90). Reliability was analyzed by Pearson's correlation and intraclass correlation coefficients (ICCs). The correlations were higher than the recommended value of 0.75, which indicated good test-retest reliability. Construct validity was demonstrated by correlation with the questionnaire medical outcome study questionnaire 36-Item Short Form Survey (SF-36). It showed significant correlation between the fields of QLQ-BM22 and the SF-36 (P≤0.001)., Conclusions: The EORTC QLQ-BM22 was translated into Brazilian Portuguese, was culturally adapted and was proven to be reliable, with face, content and construct validity.

Purpose: The breasts are important symbols of femininity and sensuality. Alterations such as breast hypertrophy can affect several aspects of women's quality of life. Breast hypertrophy is a prevalent health condition, which is treated by reduction mammaplasty. The aim of the present study was to assess sexual function and depression outcomes among breast hypertrophy patients undergoing reduction mammaplasty., Methods: Sixty breast hypertrophy patients were randomly allocated to a control group (CG) (n = 30) or a breast reduction group (BRG) (n = 30). The patients in the CG were assessed at the first appointment as well as 3 and 6 months later. The patients in the BRG were assessed preoperatively as well as 3 and 6 months postoperatively. Validated instruments, the Female Sexual Function Index and the Beck Depression Inventory, were used to assess sexual function and depression among the subjects. The results of these assessments were compared within and between groups., Results: Twenty-seven and 29 patients in the CG and the BRG, respectively, completed the 6-month follow-up period. At baseline, the groups did not differ significantly with regard to the main demographic data. In the initial assessment, the groups did not differ significantly with regard to Female Sexual Function Index or Beck Depression Inventory scores. Compared with the CG, the BRG reported better sexual function 3 (P = 0.015) and 6 (P = 0.009) months postoperatively. Regarding depression scores, the reduction mammaplasty group had better results 6 months postoperatively (P = 0.014)., Conclusions: Reduction mammaplasty positively affected sexual function and depression levels in breast hypertrophy patients.

Background: The breasts are important for a woman's psychological well-being, which may be negatively affected by distortions of breast size and shape. Improvements in self-esteem and sexuality are important psychological factors associated with motivation for cosmetic surgery. Mammaplasty is among the most sought-after and performed cosmetic procedures. The aim of this study was to evaluate the impact of aesthetic breast surgery on a woman's sexuality., Methods: This study was conducted in a plastic surgery clinic of a hospital university in Brazil, between 2009 and 2012. Forty-six patients with hypomastia and 30 patients with breast hypertrophy, who expressed the desire for aesthetic breast surgery, were selected for the study. The patients were assessed preoperatively and 6 months postoperatively using the sexual quotient-Female version scale (QS-F). The QS-F is a validated Brazilian questionnaire to assess sexual function. It contains ten items covering five domains of female sexual function: desire and interest, foreplay, excitement and harmony, comfort, and orgasm and satisfaction. Higher QS-F scores indicate better sexual functioning., Results: There was a significant increase in the mean total QS-F score after surgery in both groups (p < 0.001). No significant improvement in desire and comfort was reported by patients who underwent breast augmentation and in comfort by patients who underwent breast reduction. Improvement in sexuality after surgery was observed in both groups, which is consistent with the literature., Conclusion: Aesthetic breast surgery has a positive impact on the sexuality of patients., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Objective: To translate, culturally adapt, and validate a Brazilian Portuguese version of the Yale-Brown Obsessive Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS)., Methods: Ninety-three patients of both sexes seeking rhinoplasty were consecutively selected at the Plastic Surgery Outpatient Clinic of the Universidade Federal de São Paulo, Brazil, between May 2012 and March 2013. The BDD-YBOCS was translated into Brazilian Portuguese. Thirty patients participated in the cultural adaptation of the scale. The final version was tested for reliability in 20 patients, and for construct validity in 43 patients (correlation of the BDD-YBOCS with the Body Dysmorphic Disorder Examination [BDDE])., Results: Total Cronbach's alpha was 0.918. The BDD-YBOCS had excellent inter-rater (intra-class correlation coefficient [ICC] = 0.934; p < 0.001) and intra-rater reliability (ICC = 0.999; p < 0.001). Significant differences in BDD-YBOCS scores were found between patients with and without BDD symptoms (p < 0.001), and among patients with different levels of BDD severity (p < 0.001). A strong correlation (r = 0.781; p < 0.001) was observed between the BDDE and the BDD-YBOCS. The area under the receiver operating characteristic curve was 0.851, suggesting a very good accuracy for discriminating between presence and absence of BDD symptoms., Conclusion: The Brazilian Portuguese version of the BDD-YBOCS is a reliable instrument, showing face, content and construct validity.

Background: The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality., Objective: To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction., Methods: The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction., Results: Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups., Conclusions: Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function., (© 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Purpose: To determine the limitations of the photographs used to obtain the anthropometric measurements of the breast region., Methods: Five women, between the ages of 18 to 60 years, were evaluated. Photographs of the frontal and left and right profile views of their breasts were taken. Based on the current literature, the most commonly used anthropometric and anatomic landmarks for breast measurement were marked in their different positions. The different points were used to evaluate if the direct anthropometry was possible in a standardized way and determine how the points and the positions can to be used in any breast measurements., Results: There were some limitations to the use of defining points of the breast fold, as well as of its lower portion and lateral extension positions in both profiles., Conclusion: The defining points of the breast fold and the profile photographs have some limitations and we suggested how the points and positions can be used for breasts measurements.

Objective: To show the way to reach and stay in note 6 in the evaluation process of Medicine III of CAPES., Methods: Capes determinations were reviewed concerning this topic, grades 6 and 7, and also the difficulties and facilities of running a program that amounted to Note 6 after restructuring and being in compliance with regulations., Results: The main points to achieve and maintain Note 6 were: 1) regular production of master's and doctoral theses with appropriate distribution among all teachers; 2) average time of appropriate titration, as well as strict selection of students who resets the withdrawals and cancellations; 3) production of scientific articles in high impact journals and with academic and student participation in most part; 4) progressive and substantial increase in fundraising and patent search; 5) progressive increase in international exchanges with joint production; 6) visibility through new bilingual website and updated weekly; 7) numerous solidarity activities in research, but also in health services for the population and even in basic education; 8) rigorous selection of students (through design analysis, curriculum and teacher training program); 9) maintenance of high levels teachers production; 10) preparing new teachers for guidance through participation as co-supervision and involvement in the program to fit the needs., Conclusion: The Postgraduate Program in Translational Surgery went through difficult times; was submitted to a series of measures, adjustments, cooperation and understanding of the teaching staff, that took the program from note 3 - and almost closing - to a level of excellence keeping note 6 for three consecutive three-year periods of evaluation., Objetivo: Mostrar o caminho para alcançar e se manter na nota 6 no processo de avaliação da Medicina III da Capes., Métodos: Foram revisadas as determinações da Capes concernentes ao tema, conceitos 6 e 7, e também as dificuldades e facilidades próprias da execução de um programa que ascendeu à nota 6 após reestruturação e adequação às normas vigentes., Resultados: Os pontos principais para alcançar e manter conceito 6 foram: : 1) produção regular de teses de mestrado e doutorado com distribuição adequada entre todos os orientadores; 2) tempo médio de titulação adequado, assim como rígida seleção do alunado que zera as desistências e cancelamentos; 3) produção de artigos científicos alta em revistas de impacto e com participação docente e discente na sua grande maioria; 4) aumento progressivo e substancial da captação de recursos e busca de patentes; 5) aumento progressivo dos intercâmbios internacionais com produção conjunta; 6) visibilidade através de novo site bilíngue e atualizado semanalmente; 7) inúmeras atividades de solidariedade em pesquisa, mas também em Serviços de Saúde para a população e mesmo no ensino básico; 8) rigorosa seleção dos alunos (através de análise de projeto, currículo e programa de estágio docente); 9) manutenção de índices elevados de produção dos docentes; 10) preparação de novos docentes para orientação através de participação como co-orientação e envolvimento no programa para se adequar às necessidades., Conclusão: O Programa de Pós-Graduação em Cirurgia Translacional passou por momentos difíceis e que através de uma série de medidas, ajustes e a colaboração e compreensão do seu corpo docente pode sair da nota 3 e quase fechamento, para um nível de excelência mantendo nota 6 em três triênios seguidos.

Purpose: To compare breast measurements performed using the software packages ImageTool(r), AutoCAD(r) and Adobe Photoshop(r) with direct anthropometric measurements., Methods: Points were marked on the breasts and arms of 40 volunteer women aged between 18 and 60 years. When connecting the points, seven linear segments and one angular measurement on each half of the body, and one medial segment common to both body halves were defined. The volunteers were photographed in a standardized manner. Photogrammetric measurements were performed by three independent observers using the three software packages and compared to direct anthropometric measurements made with calipers and a protractor., Results: Measurements obtained with AutoCAD(r) were the most reproducible and those made with ImageTool(r) were the most similar to direct anthropometry, while measurements with Adobe Photoshop(r) showed the largest differences. Except for angular measurements, significant differences were found between measurements of line segments made using the three software packages and those obtained by direct anthropometry., Conclusion: AutoCAD(r) provided the highest precision and intermediate accuracy; ImageTool(r) had the highest accuracy and lowest precision; and Adobe Photoshop(r) showed intermediate precision and the worst accuracy among the three software packages.

Background: Breast region measurements are important for research, but they may also become significant in the legal field as a quantitative tool for preoperative and postoperative evaluation. Direct anthropometric measurements can be taken in clinical practice. The aim of this study was to compare direct breast anthropometric measurements taken with a tape measure and a compass., Methods: Forty women, aged 18-60 years, were evaluated. They had 14 anatomical landmarks marked on the breast region and arms. The union of these points formed eight linear segments and one angle for each side of the body. The volunteers were evaluated by direct anthropometry in a standardized way, using a tape measure and a compass., Results: Differences were found between the tape measure and the compass measurements for all segments analyzed (p>0.05)., Conclusion: Measurements obtained by tape measure and compass are not identical. Therefore, once the measurement tool is chosen, it should be used for the pre- and postoperative measurements in a standardized way., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background: Stretch marks, or striae distensae, are dermal scars and result in considerable aesthetic concern. The responsible factors for their development are poorly understood. Development of striae distensae is a rare complication after breast augmentation. Successfully treating striae distensae has always been challenging. Lasers and light devices have recently become a good therapeutic option. The fractional laser has shown encouraging results with less risk of pigmentation in the treatment of recent stretch marks., Methods: Forty-seven patients underwent breast augmentation over a period of 2 months; of these, 10 patients developed new striae distensae. They were submitted to nonablative fractionated 1550-nm erbium glass laser treatment. Response was assessed from photographs obtained before and 4 weeks after the end of treatment. Two plastic surgeons analyzed improvements clinically and photographically, and a patient satisfaction score was recorded as well., Results: There was a significant relationship between age and development of striae, (p = 0.003), but there was no significant relationship between striae distensae and nulliparity (p = 0.147), volume of the silicone implant (p = 0.892), or use of oral contraceptive (p = 1.00). The scores achieved by both the evaluators and the patients were high, with 50 percent of them between 9 and 10 (maximum scores), and with a high index of satisfaction with the treatment., Conclusions: Age is statistically significant in the development of striae distensae after breast augmentation. This report demonstrates excellent patient and plastic surgeon satisfaction after treatment. The use of fractional photothermolysis is a good treatment modality for striae rubrae.

Background: Seroma is the most common complication in abdominoplasty and abdominal ultrasound is one of the best noninvasive methods for diagnosing seroma formation. The aim of this study was to compare the use of suction drains, quilting sutures, and fibrin sealant in abdominoplasty to determine the best strategy to prevent seroma formation., Methods: Forty-three female patients, aged 20-66 years, nonsmokers, with Nahas' type III deformities, and body mass index (BMI) ranging from 18.0 to 24.9 kg/m(2), underwent abdominoplasty between March and October 2008 in a public hospital setting. The patients were randomly allocated to one of three treatment groups: DN group (n = 15), abdominoplasty with suction drains alone; QS group (n = 13), abdominoplasty with quilting suture between the subcutaneous tissue of the flap and musculoaponeurotic layer of the anterior abdominal wall; and FS group (n = 15), abdominoplasty with fibrin sealant. All patients underwent ultrasound examination on postoperative days 15 and 30 for detection of abdominal fluid collections., Results: The groups were homogeneous for age and BMI. There was a significant reduction in seroma formation between postoperative days 15 and 30 in the three groups (DN group, P = 0.0003; QS group, P = 0.0011; and FS group, P = 0.0003). Seroma formation was significantly higher in the FS group (H = 6.04, P < 0.05) compared with the DN and QS groups on postoperative day 15., Conclusion: Seroma formation was significantly lower in the DN and QS groups compared with the FS group on postoperative day 15.

Background: This randomized controlled trial was designed to assess whether dressing wear time could influence surgical-site infection rates and skin colonization. Patients' perception at self-assessment was also analyzed., Methods: Seventy patients undergoing reduction mammaplasty were randomly allocated to group I (dressing removed on postoperative day 1) or group II (dressing removed on postoperative day 6). Surgical-site infections were defined by standard criteria from the Centers for Disease Control and Prevention. Skin colonization was assessed by a culture of samples collected at predefined time points. Patients scored dressing wear time in regard to safety, comfort, and convenience., Results: Nine patients (12.9 percent) had an infection, seven from group I and two from group II (p = 0.09). There was no difference between the groups in regard to skin colonization before dressing, but on postoperative day 6, there was higher skin colonization by coagulase-negative staphylococci in group I (p = 0.000). If they had the choice, 66 percent of the patients in group I would choose to keep the dressing for 1 day, whereas 83 percent of the patients in group II would prefer to keep the dressing for 6 days (p = 0.000). Patients in group II also considered keeping the dressing for 6 days a safer choice (p < 0.05)., Conclusions: There was no difference in surgical-site infection rates between groups, but higher colonization levels were observed in group I on postoperative day 6. Most of the patients would choose to keep dressing for 6 days postoperatively, which was perceived as a safer choice., Clinical Question/level of Evidence: Therapeutic, II.

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.

This prospective study was conducted to assess the influence of antibiotics use on surgical site infections (SSI) rates after reduction mammaplasty. Patients undergoing reduction mammaplasty were assigned to group 1 (n = 50), which received intravenous cephalotin pre- and postoperatively, besides oral cephalexin for 6 days after discharge, or to group 2 (n = 50), which received no antibiotics. Patients were followed up weekly for 30 days, regarding to SSI, by a blinded surgeon. The Centers for Disease Control and Prevention definitions and classification of SSI were adopted. There was no statistical difference between the groups in regard to age, body mass index, duration of operation, and total resection weight. SSI rates were 2% and 14% in groups 1 and 2, respectively (P = 0.03). In group 2, older patients and those with higher resection weight had significant higher SSI rates (P = 0.02 and P = 0.04, respectively). We observed that antibiotics use decreased SSI rates after reduction mammaplasty.

Background: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer., Objective: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction., Methods: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test., Results: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

Background: Gynecomastia has an incidence of up to 60% of adolescents, causing pain and self-image disorders for the patient, leading to emotional and physical problems that can be reversed with treatment. This prospective case control study assessed the surgical treatment of gynecomastia and its impact on quality of life., Methods: Thirty-three patients aged 18-50 years and with 2-21 years of gynecomastia progression were included in the study. Adenectomy was performed. Preoperatively and 6 months postoperatively, patients completed the Brazilian version of the Short-Form 36 (SF-36) quality of life questionnaire., Results: There was improvement in the SF-36 domains of General Health, Functional Capacity, Social Aspects, Vitality, and Mental Health., Conclusion: The Short-Form 36 questionnaire demonstrated that surgical treatment of gynecomastia afforded positive changes in quality of life.

Background: Objective evaluation of breast asymmetry surgical treatment should consider not only breast shape but also breast volume., Methods: For this study, 22 patients with primary breast asymmetry were evaluated by magnetic resonance imaging (MRI) as well as linear measurements preoperatively and 6 months postoperatively. The mean difference between the pre- and postoperative linear measurements was graduated from excellent to poor. Breast volume was estimated by MRI from axial reconstruction for three-dimensional application using the Cavalieri formula and specific software., Results: A strong correlation (r = 0.817) was found between the pre- and postoperative breast volumes, as increased or decreased by the surgical procedure. Patients with less postoperative volume differences tended to have the best ratings with linear measurements. When the same surgical procedure was performed bilaterally or when only one breast was treated by surgery, greater volume symmetry was observed., Conclusions: Linear measurements and MRI are objective methods for evaluating postoperative symmetry, and when used in association, can help plastic surgeons to achieve favorable results in mammary asymmetry treatment.

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.

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. Cronbach's alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearson's 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.

Background: Surgical correction of breast asymmetry involves not only an acceptable aesthetic result but also physical, social, and psychological consequences on the patient's quality of life., Objective: The authors evaluated the impact of breast asymmetry surgical treatment on self-esteem and health-related quality of life in a group of 35 patients., Methods: Patients completed the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), a generic health evaluation tool that covers quality of life across 8 dimensions, and the Rosenberg Self-Esteem Scale, a specific tool for evaluating self-esteem. Both were applied before and at 3 and 6 months after surgery. Friedman two-way analysis of variance and the Tukey test were used to compare the differences between the scores and the different time periods., Results: There was a progressive improvement in all dimensions of the SF-36 that was statistically significant for 4 dimensions and self-esteem. Statistically significant differences were found for "emotional role" and "self-esteem" at 3 months after surgery and for "pain," "vitality," and "mental health" at 6 months after surgery., Conclusions: The results suggest that breast asymmetry surgical treatment provides an improvement in health-related quality of life and self-esteem.