Thesis (Ph. D.)--University of Texas at Austin, 2007. / Vita. Includes bibliographical references.

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 148-158). Available also in a digital version from Dissertation Abstracts.

Thesis (Ph.D.)--York University, 2005. Graduate Programme in Women's Studies. / Typescript. Includes bibliographical references (leaves 223-235). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pqdiss&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&rft_dat=xri:pqdiss:NR11606

Breast cancer is the most common cancer among American women. One in eight women will be diagnosed with breast cancer during her lifetime. Essentially all breast cancer treatment involves surgery. The two most generally performed surgical treatments for breast cancer are breast conservation therapy and mastectomy followed by breast reconstruction. Breast reconstructive surgery is an important component of the breast cancer treatment process. The aesthetic outcome of breast cancer treatment is a critical factor in breast cancer survivors' quality of life. Aesthetics is a general term that refers to physical characteristics such as symmetry and proportion. Currently, physicians, patients, or other observers evaluate breast aesthetics in a subjective, qualitative manner. However, such assessments are typically based on vaguely defined rating scales that have low intra- and inter-observer agreement. Their qualitative nature also restricts the analyses that can be performed. Quantitative, objective measures with high reliability are needed to meaningfully relate patient and surgical variables to aesthetic outcomes and to compare the outcomes of different kinds of breast cancer treatments (e.g., reconstruction procedures). I postulated that quantitative measures of breast aesthetic properties can be designed using clinical photographs. In this dissertation, I have designed algorithms to compute objective, quantitative, reproducible measures of breast aesthetics. I have evaluated the algorithms for computing objective measures of breast aesthetic properties such as ptosis and surgical scars from clinical photographs. A preliminary observer rating scale of 11 symmetry ratings items, 14 individual breast ratings items, and a global rating on overall appearance before and after the entire rating items was proposed. Eye-tracking technology was used to understand how plastic surgeons assess breast aesthetics by recording their gaze path while they rate breast anatomy on clinical photographs. In addition to these design and evaluation tasks, I also have used the objective measures to conduct a preliminary comparison of the aesthetic outcomes of different reconstruction procedures. / text

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

A cada dia sÃo realizadas mais reconstruÃÃes imediatas da mama pÃs-tratamento do cÃncer. Para as mastectomias radicais, hà vÃrias tÃcnicas consagradas. Na quadrantectomia, as opÃÃes de reparaÃÃo do defeito vÃo do fechamento primÃrio à utilizaÃÃo de tÃcnicas de cirurgia plÃstica redutora. Para os tumores dos quadrantes externos, nÃo havia opÃÃo para a rotaÃÃo de todo o mÃsculo LatÃssimo do dorso, que usualmente excede ao necessÃrio à reparaÃÃo do volume perdido. Na literatura, hà poucos trabalhos sobre a reconstruÃÃo pÃs-quadrantectomia e nenhum quando o assunto à quadrantes externos. Aqui à descrita uma tÃcnica que originalmente se propunha a possibilitar a reposiÃÃo do volume perdido nas quadrantectomias dos quadrantes externos de mamas pequenas, mas que se mostrou Ãtil tambÃm em casos de mamas mÃdias e em lesÃes que avanÃavam à regiÃo subareolar. A tÃcnica consiste na dissecÃÃo do segmento lateral do mÃsculo L. do dorso por um prolongamento da incisÃo para a retirada da lesÃo, no mesmo decÃbito dorsal, seguida de sua rotaÃÃo e modelagem para reparar o defeito decorrente da extirpaÃÃo do cÃncer. AlÃm da diminuiÃÃo do tempo cirÃrgico, em muitos casos, torna-se desnecessÃria a segunda cirurgia. Vinte e uma mulheres foram submetidas à quadrantectomias de quadrantes externos, seguidas da reconstruÃÃo aqui descrita. Para a avaliaÃÃo do mÃtodo, cada resultado teve atribuÃdo um escore a volume, forma, simetria e alteraÃÃes do complexo arÃolopapilar (CAP), da cicatriz e da superfÃcie do quadrante operado. A nota mÃdia foi 7,048, equivalente ao conceito âBâ, mostrando a viabilidade do mÃtodo. / Nowadays more and more immediate breast reconstructions following post cancer treatment are carried out. In the case of radical mastectomy there are a lot of recognized techniques. In the quadrantectomy, the options of defect repairing range from the primary closing to the utilization of reducing plastic surgery techniques. In the case of tumors of the external quadrants there was no option for the rotation of all the LatÃssimo do dorso muscle, which usually exceeds the necessary to repair the volume lost. In the literature there are few works about the post quadrantectomy reconstruction and no one when it deals with external quadrants. Here the technique described originally proposed to make possible the replacement of the volume lost in the quadrantectomies of the external quadrants of small breasts, but it also showed to be useful in cases of medium breasts and in lesions which move towards to the subareolar region. The technique consists in the dissection of the lateral segment of the LatÃssimo do dorso muscle by prolonging the incision to withdrawal the lesion, in the same dorsal decubitus, followed by its rotation and modeling in order to repair the defect arising out of a cancer removal. Besides the time reduction of the surgery, in many cases it is not necessary a second surgery. Twenty-one women were submitted to quadrantectomies of external quadrants followed by the reconstruction described here. In order to evaluate the method, to each result a score was attributed to volume, form, symmetry, CAP, scar and surface. The average grade was 7.048, equivalent to grade B which confirms the viability of the method.

Orientador: Ilka de Fátima Santana Ferreira Boin / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T22:02:17Z (GMT). No. of bitstreams: 1 Bueno_MarcoAntoniodeCamargo_D.pdf: 13158425 bytes, checksum: 6c0b9aa3b3a1a2372f3a983cbb2124d4 (MD5) Previous issue date: 2012 / Resumo: Muitos estudos descreveram vários aspectos técnicos a respeito do procedimento de mamoplastia redutora. Os autores apresentam suas técnicas que combinam algumas técnicas já descritas na literatura a respeito da reposição do complexo aerolopapilar (CAP), redução do diâmetro da base da mama e retenção da projeção do cone mamário em longo prazo. Este estudo avaliou os resultados de pacientes de várias idades em relação à dimensão da cicatriz, posicionamento da mama e satisfação da paciente a curto, médio e longo prazo. Método: A mamoplastia foi realizada utilizando-se a técnica do T invertido. As marcações pré- operatórias diferem daquelas descritas na literatura deixando a posição futura do CAP como ponto livre. Uma sutura circular foi utilizado para fixar a mama na fascia do músculo peitoral maior e reduzir o diâmetro da base da mama, resultando numa cicatriz horizontal reduzida no sulco inframamário. A técnica de marcação da pele permite uma melhor simetria pós-operatório apesar das variações pré- operatórias de forma e volume. Resultados: Os resultados foram considerados satisfatórios na maioria dos casos por ambos pacientes (93,7%) e médico (91,1%). O posicionamento adequado do pólo superior mamário foi mantido em 94,7% das mamas. Conclusão: Os resultados da técnica descrita foram considerados satisfatórios para pacientes em relação à redução do diâmetro da base mamária, posicionamento do CAP e projeção do pólo superior mamário em longo prazo / Abstract: Background: Many reports have described various technical aspects of reduction mammaplasty and mastopexy procedures. The authors present their technique, which combines a number of techniques already described in the literature regarding repositioning of the nipple. areola complex, reduction of the diameter of the base of the breast, and long-term retention of mammary cone projection. Objectives: This study evaluated the results for patients of various ages in terms of scar dimensions, breast positioning and patient and doctor satisfaction in the short, medium, and long terms. Methods: Mammaplasty was performed using the inverted T technique. The preoperative skin markings differed from those described in the literature not using the position of the CAP as a predetermined mark. A running circular suture was used to fix the breast to the pectorals major fascia and to reduce the diameter of the base of the breast, resulting in a reduced horizontal scar in the inframammary fold. The skin-marking technique allowed for better postoperative breast symmetry regardless of preoperative variations in shape and volume. Results: The outcomes were considered satisfactory in the majority of cases by both the patient (93.7%) and the physician (81.1%). Adequate fullness of the upper pole was maintained in 94.7% of the breasts. Conclusions: The described technique results were considered satisfactory for patients and doctor, reducing the diameter of the base of the breast, repair of ptosis, repositioning of the nipple. Areola complex and long-term upper pole fullness / Doutorado / Fisiopatologia Cirúrgica / Doutor em Ciências

Title: Testing of the postural stabilization in relation to weight changes of breasts Objectives: Aim of this study is to assess postural changes after breast reduction. To capture the level of postural stability before and after surgery and to evaluate changes between these states. Methods: This thesis is a clinical trial of one group of persons (n=12). It has been created as a quasi experiment. For testing there was used diagnostic method of postural somatooscilography (PSOG) which includes performing postural provocation test on the platform Posturomed under standard conditions. The testing was performed three times. The measurement was recorded by program Microswing 6.0, the collected data was evaluated by program Posturomed Commander and further analyzed by one - way Analysis of Variance in statistical program OpenStat. Results: Managed to prove, that breast reduction has a positive influence on postural stabilization at women suffering from gigantomastia. Status of postural stability was significantly improved two months after surgery. Keywords: postural stability, Posturomed, postural somatooscilography, gigantomastia, reduction mammaplasty

Este estudo descritivo, com abordagem qualitativa, teve como objetivo compreender como é a experiência da reconstrução mamária na vida de mulheres com câncer de mama. Para obtenção dos dados, foram realizadas entrevistas semiestruturadas com 14 mulheres submetidas à cirurgia para reconstrução mamária e cadastradas em um serviço especializado em reabilitação pós-mastectomia. Para tratamento dos dados, utilizou-se o método de análise temática proposto por Bardin, o qual proporcionou a obtenção de dois temas principais: o primeiro abordou a experiência das mulheres entre o diagnóstico e a realização da cirurgia reconstrutora e agrupou categorias referentes aos sentimentos e às atitudes das mulheres diante do diagnóstico de câncer de mama e como se deu o processo decisório pela reconstrução mamária. No segundo, as categorias estiveram relacionadas à forma como a mulher se vê, depois da reconstrução, e o que a mesma significou em sua vida, como ela percebe seus benefícios e convive com as limitações decorrentes da cirurgia reconstrutora, bem como o papel das diversas redes de apoio em sua trajetória. Neste estudo, dentre outros motivos apontados pelas mulheres na escolha da reconstrução, destacou-se a influência do médico na decisão pela cirurgia. A recuperação da mama devolveu a algumas mulheres sua autoestima e a sensação de estarem completas novamente, ajudou-as a recuperar sua autoimagem e a superar o trauma causado pela doença, proporcionando-lhes, por exemplo, a segurança para manterem ou iniciarem um relacionamento afetivo e sexual com um parceiro. As complicações no pós-operatório desencorajaram as mulheres a finalizarem a cirurgia e provocaram o medo de uma nova perda, as cicatrizes e deformidades na mama causaram insatisfação e a perda da sensibilidade do retalho ocasionou, em alguns casos, comprometimentos na esfera sexual e na percepção da neomama. Observou-se que as redes de apoio às mulheres com câncer se mostraram presentes em todas as fases do adoecer, desde o diagnóstico até a reabilitação. A família, os amigos e o grupo de reabilitação foram as fontes de suporte mais frequentes, e a participação deles mostrou-se fundamental para a reinserção das mulheres na sociedade. Os dados obtidos neste estudo podem oferecer subsídios para a implementação de ações no âmbito do atendimento às mulheres com câncer de mama, as quais devem envolver paciente, família e profissionais de saúde. / This descriptive and qualitative study aimed at understanding how is the experience of breast reconstruction in the lives of women with breast cancer. To obtain data, semi-structured interviews with 14 women undergoing surgery for breast reconstruction enrolled in a specialized rehabilitation service post-mastectomy were performed. Data processing was organized using the methodology of thematic analysis proposed by Bardin, which provided the achievement of two main themes: the first showed the experience of women during the period between diagnosis and reconstructive surgery and grouped categories related to feelings and attitudes of women after the diagnosis of breast cancer and how was the decisionmaking process for breast reconstruction. In the second, the categories were related to how the woman sees herself after reconstruction and what it meant in her life, how she realizes its benefits, how she lives with the limitations resulting from reconstructive surgery as well the role of the various support networks in her trajectory. In this study, among other reasons reported by women to choose the reconstruction, it is highlighted the influence of the physician in deciding on doing the surgery. The recovery of the breast helped to build the selfesteem to some women and restore the sense of being whole again; helped them regain their self-image and overcome the trauma caused by the disease which provided, for example, the security to maintain or initiate an affective and sexual relationship with a partner. The postoperative complications discouraged women from doing surgery and caused fear of a new loss; the scars and breast deformities caused dissatisfaction, and the loss of sensation of the areola and nipple caused, in some cases, problems in the sexual sphere and breast awareness. It was observed that the support networks for women with breast cancer assisted them in all stages of illness, from diagnosis to rehabilitation. Family, friends and the rehabilitation group were the most frequent sources of support and their participation proved vital for the reintegration of women in society. The data obtained in this study may provide support for the implementation of actions related to the care of women with breast cancer, which should involve patient, family and health professionals.