No description available.

Background: We evaluated geographic patterns for immediate and delayed breast reconstruction (IBR, DBR) in Ontario. The influence of plastic surgeon availability on rates and service provision was determined. Methods: We examined IBR and DBR from 2002 through 2011 across Ontario counties. Regional availability of plastic surgeons was described. Geographic patterns were examined using funnel plots, random-effects models and migration indices. Results: Over ½ Ontario counties have no plastic surgeons. IBR ranged from 0 to 21.5% across counties and differences in plastic surgeon availability explained 41% of variation (p < 0.0001). For DBR there was less variation. 5/45 counties performed ¾ of BR, however rates among local residents were not highest. Interpretation: Nearly 1/3 of the population has limited access to plastic surgeons, contributing to low rates of BR. Geographic access is a major determinant of IBR but is less important for DBR, however service provision for both was highly regionalized.

Background: We evaluated geographic patterns for immediate and delayed breast reconstruction (IBR, DBR) in Ontario. The influence of plastic surgeon availability on rates and service provision was determined. Methods: We examined IBR and DBR from 2002 through 2011 across Ontario counties. Regional availability of plastic surgeons was described. Geographic patterns were examined using funnel plots, random-effects models and migration indices. Results: Over ½ Ontario counties have no plastic surgeons. IBR ranged from 0 to 21.5% across counties and differences in plastic surgeon availability explained 41% of variation (p < 0.0001). For DBR there was less variation. 5/45 counties performed ¾ of BR, however rates among local residents were not highest. Interpretation: Nearly 1/3 of the population has limited access to plastic surgeons, contributing to low rates of BR. Geographic access is a major determinant of IBR but is less important for DBR, however service provision for both was highly regionalized.

OBJECTIVES : This work studies the indications, methods, results , satisfaction and partner relationships in immediate (IBR ) and deferred breast reconstruction ( DBR ) to objectively consider the benefits and indications IBR . METHOD : IBR between 1/2002-12/2012 underwent 51 ( 33.33 %) women ( 29-58 years, mean 41.5 , median 40.5 ) ; DBR 102 ( 66.67 %) ( 31-64 , mean 47.5 , median 47 ), data were obtained from medical records , questionnaires interviews and questionnaires , processed by statistical analysis RESULTS : Indications IBR : ≤ pT2N0M0 , low grade tumor ; DBR : ≥ 1 year of remission. Age at IBR was lower than the DBR ( p- 0.0004 ) Statistical differences in the modes of life after reconstruction the IBR a DBR were observed ( p- 0.1935-0.9659 ) predominates full and prevailing contentment. IBR does not burden patients ( 55 to 160 min, average 91.1 and 139.3 min, median 75 and 135 min ) between unilateral and bilateral operations are not statistically significant differences ( p -value 0.1065 ) . Complications prolonging healing rare - IBR 5 ( 8.33 %) , DBR 6 ( 5.8 % ) and mortality generalization low - IBR and 1 ( 1.96 % s ) DBR 1 and 2 ( 0.98 % and 1 , 96%) . Satisfaction with IBR was reported by 84.09 % , with 86.11 % DBR . The DBR was found 4 times greater risk of life or relationship. SUMMARY:...

OBJECTIVES : This work studies the indications, methods, results , satisfaction and partner relationships in immediate (IBR ) and deferred breast reconstruction ( DBR ) to objectively consider the benefits and indications IBR . METHOD : IBR between 1/2002-12/2012 underwent 51 ( 33.33 %) women ( 29-58 years, mean 41.5 , median 40.5 ) ; DBR 102 ( 66.67 %) ( 31-64 , mean 47.5 , median 47 ), data were obtained from medical records , questionnaires interviews and questionnaires , processed by statistical analysis RESULTS : Indications IBR : ≤ pT2N0M0 , low grade tumor ; DBR : ≥ 1 year of remission. Age at IBR was lower than the DBR ( p- 0.0004 ) Statistical differences in the modes of life after reconstruction the IBR a DBR were observed ( p- 0.1935-0.9659 ) predominates full and prevailing contentment. IBR does not burden patients ( 55 to 160 min, average 91.1 and 139.3 min, median 75 and 135 min ) between unilateral and bilateral operations are not statistically significant differences ( p -value 0.1065 ) . Complications prolonging healing rare - IBR 5 ( 8.33 %) , DBR 6 ( 5.8 % ) and mortality generalization low - IBR and 1 ( 1.96 % s ) DBR 1 and 2 ( 0.98 % and 1 , 96%) . Satisfaction with IBR was reported by 84.09 % , with 86.11 % DBR . The DBR was found 4 times greater risk of life or relationship. SUMMARY:...

A cirurgia de reconstrução de mama é uma ferramenta cirúrgica de importância ímpar para reparar os defeitos e assimetrias causadas pelos vários tipos de tratamentos cirúrgicos do Câncer de mama. Várias técnicas e táticas têm sido demosntradas e aplicadas nos últimos anos. Muitos são os estágios em que se encontram os pacientes e vários são os esquemas de abordagem terapêutica para diferentes estágios e tipos histológicos que se apresentam. Tratamentos quimioterápicos pré ou pós-operatório, tratamento radioterápico no pós-operatório quase imediato, mastectomias preventivas, setores amplos em diferentes quadrantes, quadrantectomias, todos estes são vários aspectos de tratamento de uma mesma patologia, porém com estágios e características histológicas e moleculares diferenciadas. Como alternativa cirúrgica para reconstrução de mama em câncer de mama, nos casos em que está indicada a quadrantectomia e/ou setor de mama, independentemente da localização na mama, é que propusemos uma técnica de uso de enxerto autólogo da mama contralateral para manter a forma e a simetria mamária associada a técnicas cirúrgicas de mamoplastias. Objetivo: O objetivo do presente estudo foi avaliar o uso de enxerto de mama contralateral associada a outras técnicas de cirurgia mamária já descritas por outros autores e acompanhar o resultado quanto à estética e simetria mamária no pós-operatório imediato e após o tratamento radioterápico. Comparar os resultados com as mamas do pré-operatório e avaliar a simetria e a estética no pós-operatório. Métodos: Foram incluídos neste estudo 42 pacientes com diferentes tratamentos, porém todas com indicação cirúrgica semelhantes: setor de mama ou quadrantectomia, seguidos de radioterapia. Todos os casos foram fotografados no pré-operatório e mais de 3 meses pós-tratamento radioterápico. Foi utilizada uma escala contínua para avaliar o grau de simetria mamária no pós-operatório de mais de 3 meses de radioterapia. A escalala de medição se baseou numa régua milimétrica de 0 a 10 cm. Foi solicitado a quatro especialistas na área para colocar uma marca na escala com relação à simetria e ao aspecto estético das mamas. As notas de cada paciente foram avaliadas estatisticamente. Resultados: Os resultados foram estatisticamente significativos para a avaliação estética e para a simetria mamária pós-cirurgia e radioterapia. Conclusão: Cocluímos que o enxerto autólogo de mama contralateral em cirurgia de reconstrução de mama é um procedimento que, quando utilizado com outras técnicas, traz um resultado estético e simétrico adequado, desta forma mostrando mais uma alternativa para cirurgia de reconstrução mamária. / Background: The Breast Reconstruction surgery is a surgical tool of unparalleled importance to repair the defects and asymmetries caused by various types of surgical breast cancer treatment. Various techniques and tactics has been demonstrated and applied in recent years. Many patients are at different stages of the disease and several are the sorts of therapeutic approaches for different stages and histologic types that feature. Neo adjuvant chemotherapy treatments or postoperative chemotherapy, radiotherapy in almost immediately after surgery, preventive mastectomies, removing large breast tissue in different quadrants, quadrantectomies. All these are various aspects of treatment of the same disease however to different stages and histological and molecular characteristics. As a surgical alternative to breast reconstruction in breast cancer, where it is indicated quadrantectomy and or wide resection of breast tissue in the same quadrant, regardless of location in the breast that I proposed a technique contralateral breast grafiting replacement to keep shape and breast symmetry. Objetive: The aim of this study was to evaluate the contralateral breast graft associated with other breast surgery techniques already described by other authors, and follow the aesthetic result in the immediate postoperative period and after three months of radiotherapy. Compare the results with those of preoperative breast, and evaluate the symmetry postoperatively and proper aesthetic result. Methods: The study included 42 patients. Each case with different proposals for treatment, but all with similar surgical indication, wide resection of the breast or quadrantectomy, followed by radiotherapy. All cases were photographed in their preoperative, “pre radiotherapy” and three months post radiotherapy. A continuous scale was used to assess the degree of mammary symmetry in these patients in the post operative period of three months after radiotherapy. The measurement was based on a rule millimeter scale from 0 to 10 cm. We were asked to four experts in the field to put a mark on the scale with respect to symmetry and aesthetic appearance of the breasts. The scores of each patient were evaluated statistically. Results: The results were statistically significant for the aesthetic evaluation of the breasts and also for evaluation of the symmetry of the breasts after surgery and radiotherapy. Conclusion: We concluded that autologous graft contralateral breast in breast reconstruction surgery is a procedure that when used with other techniques, brings an aesthetic and suitable symmetrical result thus showing an alternative to breast reconstruction surgery.

A cirurgia de reconstrução de mama é uma ferramenta cirúrgica de importância ímpar para reparar os defeitos e assimetrias causadas pelos vários tipos de tratamentos cirúrgicos do Câncer de mama. Várias técnicas e táticas têm sido demosntradas e aplicadas nos últimos anos. Muitos são os estágios em que se encontram os pacientes e vários são os esquemas de abordagem terapêutica para diferentes estágios e tipos histológicos que se apresentam. Tratamentos quimioterápicos pré ou pós-operatório, tratamento radioterápico no pós-operatório quase imediato, mastectomias preventivas, setores amplos em diferentes quadrantes, quadrantectomias, todos estes são vários aspectos de tratamento de uma mesma patologia, porém com estágios e características histológicas e moleculares diferenciadas. Como alternativa cirúrgica para reconstrução de mama em câncer de mama, nos casos em que está indicada a quadrantectomia e/ou setor de mama, independentemente da localização na mama, é que propusemos uma técnica de uso de enxerto autólogo da mama contralateral para manter a forma e a simetria mamária associada a técnicas cirúrgicas de mamoplastias. Objetivo: O objetivo do presente estudo foi avaliar o uso de enxerto de mama contralateral associada a outras técnicas de cirurgia mamária já descritas por outros autores e acompanhar o resultado quanto à estética e simetria mamária no pós-operatório imediato e após o tratamento radioterápico. Comparar os resultados com as mamas do pré-operatório e avaliar a simetria e a estética no pós-operatório. Métodos: Foram incluídos neste estudo 42 pacientes com diferentes tratamentos, porém todas com indicação cirúrgica semelhantes: setor de mama ou quadrantectomia, seguidos de radioterapia. Todos os casos foram fotografados no pré-operatório e mais de 3 meses pós-tratamento radioterápico. Foi utilizada uma escala contínua para avaliar o grau de simetria mamária no pós-operatório de mais de 3 meses de radioterapia. A escalala de medição se baseou numa régua milimétrica de 0 a 10 cm. Foi solicitado a quatro especialistas na área para colocar uma marca na escala com relação à simetria e ao aspecto estético das mamas. As notas de cada paciente foram avaliadas estatisticamente. Resultados: Os resultados foram estatisticamente significativos para a avaliação estética e para a simetria mamária pós-cirurgia e radioterapia. Conclusão: Cocluímos que o enxerto autólogo de mama contralateral em cirurgia de reconstrução de mama é um procedimento que, quando utilizado com outras técnicas, traz um resultado estético e simétrico adequado, desta forma mostrando mais uma alternativa para cirurgia de reconstrução mamária. / Background: The Breast Reconstruction surgery is a surgical tool of unparalleled importance to repair the defects and asymmetries caused by various types of surgical breast cancer treatment. Various techniques and tactics has been demonstrated and applied in recent years. Many patients are at different stages of the disease and several are the sorts of therapeutic approaches for different stages and histologic types that feature. Neo adjuvant chemotherapy treatments or postoperative chemotherapy, radiotherapy in almost immediately after surgery, preventive mastectomies, removing large breast tissue in different quadrants, quadrantectomies. All these are various aspects of treatment of the same disease however to different stages and histological and molecular characteristics. As a surgical alternative to breast reconstruction in breast cancer, where it is indicated quadrantectomy and or wide resection of breast tissue in the same quadrant, regardless of location in the breast that I proposed a technique contralateral breast grafiting replacement to keep shape and breast symmetry. Objetive: The aim of this study was to evaluate the contralateral breast graft associated with other breast surgery techniques already described by other authors, and follow the aesthetic result in the immediate postoperative period and after three months of radiotherapy. Compare the results with those of preoperative breast, and evaluate the symmetry postoperatively and proper aesthetic result. Methods: The study included 42 patients. Each case with different proposals for treatment, but all with similar surgical indication, wide resection of the breast or quadrantectomy, followed by radiotherapy. All cases were photographed in their preoperative, “pre radiotherapy” and three months post radiotherapy. A continuous scale was used to assess the degree of mammary symmetry in these patients in the post operative period of three months after radiotherapy. The measurement was based on a rule millimeter scale from 0 to 10 cm. We were asked to four experts in the field to put a mark on the scale with respect to symmetry and aesthetic appearance of the breasts. The scores of each patient were evaluated statistically. Results: The results were statistically significant for the aesthetic evaluation of the breasts and also for evaluation of the symmetry of the breasts after surgery and radiotherapy. Conclusion: We concluded that autologous graft contralateral breast in breast reconstruction surgery is a procedure that when used with other techniques, brings an aesthetic and suitable symmetrical result thus showing an alternative to breast reconstruction surgery.

A cirurgia de reconstrução de mama é uma ferramenta cirúrgica de importância ímpar para reparar os defeitos e assimetrias causadas pelos vários tipos de tratamentos cirúrgicos do Câncer de mama. Várias técnicas e táticas têm sido demosntradas e aplicadas nos últimos anos. Muitos são os estágios em que se encontram os pacientes e vários são os esquemas de abordagem terapêutica para diferentes estágios e tipos histológicos que se apresentam. Tratamentos quimioterápicos pré ou pós-operatório, tratamento radioterápico no pós-operatório quase imediato, mastectomias preventivas, setores amplos em diferentes quadrantes, quadrantectomias, todos estes são vários aspectos de tratamento de uma mesma patologia, porém com estágios e características histológicas e moleculares diferenciadas. Como alternativa cirúrgica para reconstrução de mama em câncer de mama, nos casos em que está indicada a quadrantectomia e/ou setor de mama, independentemente da localização na mama, é que propusemos uma técnica de uso de enxerto autólogo da mama contralateral para manter a forma e a simetria mamária associada a técnicas cirúrgicas de mamoplastias. Objetivo: O objetivo do presente estudo foi avaliar o uso de enxerto de mama contralateral associada a outras técnicas de cirurgia mamária já descritas por outros autores e acompanhar o resultado quanto à estética e simetria mamária no pós-operatório imediato e após o tratamento radioterápico. Comparar os resultados com as mamas do pré-operatório e avaliar a simetria e a estética no pós-operatório. Métodos: Foram incluídos neste estudo 42 pacientes com diferentes tratamentos, porém todas com indicação cirúrgica semelhantes: setor de mama ou quadrantectomia, seguidos de radioterapia. Todos os casos foram fotografados no pré-operatório e mais de 3 meses pós-tratamento radioterápico. Foi utilizada uma escala contínua para avaliar o grau de simetria mamária no pós-operatório de mais de 3 meses de radioterapia. A escalala de medição se baseou numa régua milimétrica de 0 a 10 cm. Foi solicitado a quatro especialistas na área para colocar uma marca na escala com relação à simetria e ao aspecto estético das mamas. As notas de cada paciente foram avaliadas estatisticamente. Resultados: Os resultados foram estatisticamente significativos para a avaliação estética e para a simetria mamária pós-cirurgia e radioterapia. Conclusão: Cocluímos que o enxerto autólogo de mama contralateral em cirurgia de reconstrução de mama é um procedimento que, quando utilizado com outras técnicas, traz um resultado estético e simétrico adequado, desta forma mostrando mais uma alternativa para cirurgia de reconstrução mamária. / Background: The Breast Reconstruction surgery is a surgical tool of unparalleled importance to repair the defects and asymmetries caused by various types of surgical breast cancer treatment. Various techniques and tactics has been demonstrated and applied in recent years. Many patients are at different stages of the disease and several are the sorts of therapeutic approaches for different stages and histologic types that feature. Neo adjuvant chemotherapy treatments or postoperative chemotherapy, radiotherapy in almost immediately after surgery, preventive mastectomies, removing large breast tissue in different quadrants, quadrantectomies. All these are various aspects of treatment of the same disease however to different stages and histological and molecular characteristics. As a surgical alternative to breast reconstruction in breast cancer, where it is indicated quadrantectomy and or wide resection of breast tissue in the same quadrant, regardless of location in the breast that I proposed a technique contralateral breast grafiting replacement to keep shape and breast symmetry. Objetive: The aim of this study was to evaluate the contralateral breast graft associated with other breast surgery techniques already described by other authors, and follow the aesthetic result in the immediate postoperative period and after three months of radiotherapy. Compare the results with those of preoperative breast, and evaluate the symmetry postoperatively and proper aesthetic result. Methods: The study included 42 patients. Each case with different proposals for treatment, but all with similar surgical indication, wide resection of the breast or quadrantectomy, followed by radiotherapy. All cases were photographed in their preoperative, “pre radiotherapy” and three months post radiotherapy. A continuous scale was used to assess the degree of mammary symmetry in these patients in the post operative period of three months after radiotherapy. The measurement was based on a rule millimeter scale from 0 to 10 cm. We were asked to four experts in the field to put a mark on the scale with respect to symmetry and aesthetic appearance of the breasts. The scores of each patient were evaluated statistically. Results: The results were statistically significant for the aesthetic evaluation of the breasts and also for evaluation of the symmetry of the breasts after surgery and radiotherapy. Conclusion: We concluded that autologous graft contralateral breast in breast reconstruction surgery is a procedure that when used with other techniques, brings an aesthetic and suitable symmetrical result thus showing an alternative to breast reconstruction surgery.

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor. Vid omfattande tumörväxt utförs mastektomi. Hela bröstet inklusive all lymfkörtelvävnad i axillen tas bort. Att få beskedet om att bröstet skall tas bort är en chock och upplevs av många som en livskris. Brösten är en central del i både det fysiska och det psykiska jaget hos de flesta kvinnor. Syfte: Att beskriva upplevelse hos kvinnor i fertil ålder som har genomgått mastektomi. Metod: En kvalitativ litteraturstudie baserad på elva artiklar med kvalitativ ansats. Resultat: I resultatet framkom fem teman: Inverkan på kroppsuppfattning, förändringar i sexuella livet, inverkan på psykiska tillstånd, behov av stöd för att bidra till bra livskvalitet och positiva upplevelser efter cancerbehandlingar. Kvinnor som genomgått mastektomi upplevde negativa förändringar i sin kroppsuppfattning som påverkade flera aspekter i livet såsom sexualitet, partnerskap, föräldraskap och relationer i arbetslivet. Kliniska implikationer: Sjuksköterskans lyhördhet till kvinnor och förståelse av deras kroppsliga och psykosociala förändringar är förutsättningarna för att lindra kvinnornas lidande och främja välbefinnande trots bröstcancersjukdomen och mastektomin. / Background: Breast cancer is the most common cancer among women. At extensive tumor growth a mastectomy is performed. The entire breast including all the lymph node tissue in in the armpit is removed. Getting the news that the breast has to be removed is a shock and is perceived by many as a life crisis. The breasts are a central part of both the physical and the mental self of most women. Aim: To describe women of reproductive age experience of having undergone mastectomy. Methods: A qualitative literature study based on eleven articles with qualitative approach was made. Results: The result shows five themes: Influence of body image, changes in sexual life, influence on mental conditions, the need for assistance to obtain a good quality of life and positive experiences after cancer treatments. Women who underwent mastectomy experienced negative changes in their body image that affected many aspects of life such as sexuality, partnership, parenthood and relationships in their professional life. Clinical implications: The nurse's responsiveness to women and understanding of their physical and psychosocial changes are prerequisites to alleviate women's suffering and promote well-being in spite of breast disease and mastectomy.

Bröstcancer drabbar cirka en miljon kvinnor världen över varje år och det är den vanligaste cancerformen hos kvinnor i Sverige idag. Kirurgi är ofta det primära valet av behandling. I vissa fall är kvinnan tvungen att ta bort hela bröstet, en så kallad mastektomi. Att förlora ett bröst innebär både fysiska och psykiska förändringar för kvinnan och många olika aspekter av hennes liv påverkas. Därför väljer en del kvinnor att göra en bröstrekonstruktion. Syftet med studien är att belysa kvinnors upplevelse av bröstrekonstruktion i samband med bröstcancer eller vid risk för bröstcancer. Studien genomfördes som en allmän litteraturstudie där 11 kvantitativa och kvalitativa vetenskapliga artiklar analyserades. Resultatet visar att kvinnor som gjort en bröstrekonstruktion i allmänhet är nöjda. Emellertid finns det även ett antal kvinnor som känner sig missnöjda. Av studien framgår att de två viktigaste aspekterna till kvinnors missbelåtenhet över bröstrekonstruktionen grundar sig i bristande information och otillräckligt stöd från sjukvården. Således är det en viktig uppgift för sjukvården att bistå dessa kvinnor med större psykosocialt stöd och tydligare information i form av bilder, filmer, informationshäften samt berättelser från kvinnor som har liknande erfarenheter. / Breast cancer affects approximately one million women worldwide each year and it is the most common cancer among women in Sweden today. Surgery is often the primary choice of treatment. In some cases the woman has to remove the entire breast, mastectomy. Losing a breast causes both physical and psychological changes in a woman and affects different aspects of her life. That is why some women choose to do a breast reconstruction. The purpose of this study is to highlight women´s experience of breast reconstruction in connection with breast cancer or in case of risk for breast cancer. The study was carried out as a literature study and 11 quantitative and qualitative scientific articles were analyzed. The results show that women who have breast reconstruction after mastectomy are generally satisfied. However, there are also a number of women who are dissatisfied. The study shows that the two main aspects of women´s dissatisfaction over the breast reconstruction are based on insufficient information and inadequate support from health care. It is an important task for health care to assist these women with a greater psychosocial support and more evident information for example photos, videos, booklets and stories from women who have similar experiences.