Orientador: Stelio Pacca Loureiro Luna / Coorientador: Fábio Futema / Banca: Francisco José Teixeira Neto / Banca: Juliana Tabarelli Brondani / Resumo: A anestesia por tumescência é uma técnica empregada em cirurgias oncológicas que necessitem amplas margens de ressecção. Como características principais produz analgesia trans e pós-operatórias, reduz o sangramento cirúrgico e facilita a divulsão tecidual. O objetivo deste estudo foi estabelecer a técnica de anestesia por tumescência para mastectomia unilateral em cadelas e compará-la com o uso de fentanil intravenoso. De forma prospectiva, aleatória, encoberta e comparativa, foram realizadas cirurgias de mastectomia unilateral em 20 cadelas, com idades de 5 a 13 anos e peso médio de 13,57 ± 9,57 kg, divididas em dois grupos: GT - onde se realizou a anestesia por tumescência com solução de lidocaína a 0,275% e GF, cujos animais foram tratados com fentanil IV na dose de 2,5 mcg/kg. A anestesia foi induzida com propofol e mantida com isofluorano. Foram avaliados os parâmetros FC, PAS, PAM, PAD, PVC, f, SpO2, ETCO2, FiIso, ETIso e T no transoperatório e FC, f, T, EAVsed, EAVdor, EDGM, EDUM e estesiometria no pós-operatório. Adicionalmente foi avaliada a exequibilidade da cirurgia, quanto ao sangramento, exérese e complicações pós-operatórias concernentes à cicatrização. Conclui-se que, quando comparada ao uso trans-operatório do fentanil IV, a técnica de anestesia por tumescência para cirurgia de mastectomia unilateral em cadelas é facilmente factível em casos de tumores mamários não aderidos, inflamados ou ulcerados; reduziu a necessidade de anestésico inalatório no período trans-operatório; apresentou uma analgesia pós-operatória superior; não produziu, em nenhum animal, níveis considerados tóxicos de lidocaína plasmática para a espécie e, portanto, não causou sinais de intoxicação, o que a torna segura nas condições e concentrações aqui descritas; não alterou a recuperação anestésica e facilitou o procedimento cirúrgico, dada a redução do sangramento trans-operatório e do tempo ... / Abstract: Tumescent anesthesia is a widely used technique in oncologic surgeries where large resection margins are necessary. This technique produces trans and postoperative analgesia, reduces surgical bleeding and facilitates tissue divulsion. The aim of this study was to establish the tumescent anesthesia technique and compare with the use of IV fentanyl in bitches submitted to unilateral mastectomy. Unilateral mastectomies were performed in 20 dogs, aging from 5 to 13 years, and weighing 13.57±9.57 kg, using a prospective, randomized, blinded and comparative design. Dogs were equally divided into two groups. Dogs from GT underwent tumescent anesthesia with 0,275% lidocaine solution and dogs from GF were treated with 2.5 mcg / kg of fentanyl IV transoperatively. Anesthesia was induced with propofol and maintained with isoflurane. Heart and respiratory rates, systolic, mean and diastolic arterial blood pressure, central venous pressure, SpO2, ETCO2, inspired and expired isoflurane concentration and temperature were measured trans-operatively and visual analogue scale for sedation and pain, Glasgow composite and Melbourne pain scales were measured postoperatively. The quality of the surgical approach, considering bleeding and ability for resection, and incidence of postoperative wound complications were investigated by the surgeon. It was concluded that tumescent anesthesia in bitches submitted to unilateral mastectomy is easy to perform in non-adhered, non-inflamed and non-ulcered mamary tumours and did not produce toxic levels of plasma lidocaine concentrations and therefore signs of intoxication. According to that this technique may be considered safe when used according to the conditions of this study. When compared to the trans-operative use of fentanyl, tumescent anesthesia reduced the inspired and expired isoflurane concentrations and improved postoperative analgesia. Tumescent anesthesia did not modify the anesthetic recovery and improved ... / Mestre

Bakgrund: Bröstcancer är den vanligaste cancerformen hos kvinnor. Dess behandlingar inverkar på kvinnors kroppsbild och sexualitet vilket påverkar välbefinnandet och samlivet med andra människor. För att som sjuksköterska kunna hjälpa och stödja dessa kvinnor är det viktigt att undersöka hur kvinnor upplever dessa omställningar. Syfte: Att belysa bröstcancerdrabbade kvinnors upplevelser av sin kroppsbild och sexualitet efter en mastektomi och de bieffekter som medföljer. Metod: Litteraturbaserad studie med utgång i kvalitativa studier grundad på 17 vetenskapliga artiklar som analyserats. Resultat: I resultatet framkom tre teman, Upplevelser av förändrad kroppsbild, Upplevelser av förändrad sexualitet och Upplevelser av sjuksköterskors kommunikativa och stödjande förmåga avseende sexuella behov, med sju tillhörande subteman. Slutsats: En god relation till sin kroppsbild och sin sexualitet är en förutsättning för att uppleva välbefinnande och livskvalité. Sjuksköterskor bör ha detta i åtanke och arbeta mer informativt och stödja bröstcancerdrabbade kvinnor i deras kamp med att bibehålla sin identitet och främja deras hälsa. / Background: Breast cancer is the most common cancer in women. Its treatments affect women's body image and sexuality, which affects the well-being and intimacy with other people. For a nurse to help and support these women, it is important to examine how women experience these changes. Purpose: To highlight breast cancer affected women's experiences of their body image and sexuality after a mastectomy and the side effects that follows. Method: Literature-based study with output in qualitative studies based on 17 scientific articles which were analyzed. Results: The results revealed three themes: Experiences of altered body image, Experiences of altered sexuality and Experiences of nurses' communicative and supportive ability regarding sexual needs, with seven additional subthemes. Conclusion: A good relationship with one’s body image and one’s sexuality is an essential factor for experiencing well-being and quality of life. Nurses should keep this in mind and work more informative and support breast cancer affected women in their struggle to maintain their identity and promote their health.

The complexity of breast-specific body image concerns among women considering cosmetic breast surgery (CBS) underscores the need for a nuanced assessment tool. Despite numerous existing body image measures, there remains a need for a concise, validated instrument focusing on satisfaction with breast appearance. The development of the Breast Appearance Concerns Scale (BACS) aimed at assessing the multifaceted nature of breast-specific concerns through a patient centered lens within a population of otherwise healthy young adult women. The BACS was developed through a comprehensive review of existing literature and refined using exploratory and confirmatory factor analyses, in addition to Rasch measurement analysis. The scale's psychometric properties were evaluated, including its internal consistency, test-retest reliability, divergent validity, and predictive validity through its relationship with established measures of appearance investment, self-esteem, anxiety, and depression. The BACS demonstrated a robust two-factor structure, emphasizing nipple-areola satisfaction and general breast satisfaction, with good internal consistency and test-retest reliability. The scale's divergent validity was supported by significant correlations with related psychological measures, establishing its distinctiveness in assessing breast-specific concerns. Discriminant analyses highlighted the scale's predictive efficacy, particularly for general breast satisfaction in relation to CBS consideration. The BACS scales also demonstrated superior specificity and sensitivity compared to other measures of psychological functioning. These findings indicate that the BACS is a reliable and valid instrument, offering deeper insights into the motivations behind CBS. While the scale has potential to improve the clinical consultation process, further research and refinement of the scale is needed to establish its broader applicability. Future directions should explore the BACS's comparative effectiveness with other instruments, its relevance across diverse populations, and its potential to predict post-surgical satisfaction. This study contributes to the ongoing efforts to address body image concerns and improve the quality of care for individuals considering CBS.

Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.

Submitted by Rosivalda Pereira (mrs.pereira@ufma.br) on 2017-08-11T20:09:50Z No. of bitstreams: 1 EdgarDiniz.pdf: 5149375 bytes, checksum: 8cb2b4fa48d3b167b6608a2de4544221 (MD5) / Made available in DSpace on 2017-08-11T20:09:50Z (GMT). No. of bitstreams: 1 EdgarDiniz.pdf: 5149375 bytes, checksum: 8cb2b4fa48d3b167b6608a2de4544221 (MD5) Previous issue date: 2011-05-06 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPQ) / Surgery simulation is as a powerful tool to aid health care professionals. Among its applications, we can highlight virtual training, preview of surgery outcome, support for the choice of best procedure and doctor-patient communication improvement. This work presents a methodology for breast surgery simulation using solid nite elements. We build the models from mammographic images. We discuss all the steps required to build the breast nite elements model: image segmentation, breast volume reconstruction, surface mesh extraction, volume mesh generation, and breast materials de nition. The surgery is simulated by tissue removal and suture operations. An application to de ne the models was developed and the Abaqus suite is used to perform the simulations. / A simulação de procedimentos cirúrgicos apresenta-se como uma poderosa ferramenta de auxílio ao profissional de saúde. Entre suas aplicações, destacam-se treinamento virtual, previsão de resultados, auxílio na decisão do melhor procedimento a ser executado e melhoria na comunicação médico-paciente. Este trabalho apresenta uma metodologia para simulação de cirurgia mamária usando elementos finitos. Os modelos são construídos a partir de imagens de mamografia. Discutimos todas as etapas para a geração do modelo de elementos finitos da mama: segmentação das imagens, extração da malha de superficie, geração da malha volumétrica, definição dos materiais dos tecidos. A cirurgia é simulada através das operações de remoção de tecido e sutura. Foi desenvolvida uma aplicação com as funcionalidades de definição do modelo e utilizado o pacote Abaqus para a realização da simulação.

Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.

Introdução: o status dos linfonodos axilares permanece um dos mais importantes fatores prognósticos no carcinoma de mama em estágios iniciais, além de definir o uso de terapias complementares. A biópsia de linfonodo sentinela (BLNS) surgiu com a finalidade de estadiar a axila com o mínimo de morbidade, tendo como objetivo a identificação e o estudo patológico do primeiro linfonodo axilar proveniente da drenagem linfática da mama. Pacientes com axila clinicamente negativa têm indicação de biópsia de linfonodo sentinela como método de estadiamento da axila, e quando o resultado era positivo para metástase recomendava-se o esvaziamento axilar. Por recomendação do ACOSOG Z0011, o esvaziamento axilar (EA) após uma biópsia de linfonodo sentinela positivo não é necessário. Esse estudo demonstrou não haver benefício em realizar o EA na presença de LNS positivo na sobrevida global ou na sobrevida livre de doença. Objetivos: Avaliar a taxa de recidiva e morte em pacientes submetidas à cirurgia conservadora de mama e BLNS positiva com posterior esvaziamento axilar no Hospital de Clínicas de Porto Alegre; e, como objetivo secundário, avaliar as características clínicas e patológicas dessa população. Método: foi realizado um estudo de coorte retrospectiva, incluindo pacientes com diagnóstico de carcinoma de mama invasor submetidas à cirurgia conservadora da mama e BLNS, cujo resultado foi positivo para presença de metástases, e foram submetidas ao EA o período de janeiro de 2004 a dezembro de 2008. Resultados: foram incluídas 144 pacientes submetidas à biópsia de linfonodo sentinela e CCM; 33 tiveram o achado de biópsia de linfonodo sentinela positivo para metástase, e dessas 33 pacientes restaram 27 para análise dos dados. A taxa de sucesso na identificação do LNS foi de 0,96. A idade média das pacientes foi de 53,8 anos, o número de LNS ressecados foi de 1,6 por paciente; a média do tamanho tumoral foi de 2,3 cm. Seis pacientes apresentaram doença axilar residual correspondendo a 22,2% da amostra e tiveram um risco relativo de morte de 3 vezes mais para aquelas sem doença axilar residual e 50% a mais de desenvolvimento de metástases. Conclusão: O comprometimento axilar é importante fator no prognóstico das pacientes com câncer de mama, quanto maior o comprometimento da axilar pior será o desfecho de sobrevida livre de doença e de morte. Acreditamos que se pode aplicar a conduta do ACOSOG Z0011 também nas pacientes do HCPA devido à alta sensibilidade do método no nosso meio. / Introduction: The status of axillary lymph nodes remains one of the most important prognostic factors in breast carcinoma in the early stages, in addition it helps to defining the use of complementary therapies. Sentinel lymph node biopsy (SLNB) was developed with the purpose of staging the axilla with minimal morbidity, aiming at the identification and pathological study of the first axillary lymph node from the lymphatic drainage of the breast. Patients with clinically negative lymph node have indication of SLNB as a method of axillary staging, and with a positive finde for metastasis the axilar clereance was performed. Nowadays, due to the ACOSOG Z0011 Study, the axillary dissection (AD) after a positive SLNB for metastasis was put in check. This estudy have as a result no difference in global survive ou disease free survive if ALND was not performed in a positive SLNB. In the present study, we intend to evaluate the clinical and histopathological characteristics of patients submitted to breast conservative surgery and sentinel lymph node biopsy with a positive result for metastasis. Main objective: Evaluate the rate of recurrence and death in patients submitted to conservative breast surgery and BLNS with posterior axillary emptying at Hospital de Clínicas, Porto Alegre. It is a secondary objective to evaluate the clinical and pathological characteristics of this population. Material and Methods: A retrospective cohort study was performed, including 144 patients diagnosed with invasive breast carcinoma submitted to conservative breast surgery and SLNB, whose results were positive for metastases, and were submitted to AD, at the Mastology Unit of the Hospital de Clinicas de Porto Alegre (HCPA), from January 2004 to December 2008. Results: Of 144 patients submitted to SLNB and BCS, 33 had SLNB positive for metastasis, of these 33 patients remained 27 for data analysis. The success rate in LNS identification was 0.96. The mean age of the patients was 53.8 years, the number of resected SLN was 1.6 per patient; The mean tumor size was 2.3 cm. Six patients had residual axillary disease corresponding to 22.2% of the sample and had a relative risk of death of 3 times more for those without residual axillary disease and 50% more for the development of metastases. Conclusion: Axillary involvement is an important factor in the prognosis of patients with breast cancer, and the greater the axillary impairment, the worse the diseasefree survival outcome and death. We believe that the ACOSOG Z0011 trial can also be applied to HCPA patients who meet the inclusion criteria for this purpose, due to the high sensitivity of the method in our environment.

Black women are most likely to receive mastectomies, yet the least likely to have receipt of breast reconstruction. This disparity in breast and plastic surgery care is unethical and has been documented in the literature and has been witnessed clinically, but far most importantly, it is continued to be lived by Black women all over the nation. The bioethical principles of agency and social justice are called into question as Black women are not given an adequate understanding of their reconstructive options and are not being treated equally or equitably by the healthcare system. As noted by literature, race and ethnicity, socioeconomic and insurance status as well as comorbidities are contributing to this gap in care. As far as solutions go, there must be a multifaceted approach to mitigating this disparity. I have adopted Dr. Butler’s categorization of solutions to understand the exact approach we need to have, which includes patient education, legislation and academic medical institution, to make the recovery from breast cancer ethical for all women. In this thesis, I will go through the literature and garner perspectives from surgeons as well as patients who received breast reconstruction to aid in the understanding of this disparity and what needs to be done to fix it. / Urban Bioethics

This research project examines the experiences of women who have undergone elective cosmetic breast surgery. Drawing from qualitative in-depth interviews with twenty four women, this study examines why these women were willing to undergo dangerous and invasive cosmetic surgery procedures to change the appearance of their breasts. It is argued that although the women exercised agency in their decision-making, their choices were severely constrained by a culture that rewards women for conforming to feminine beauty norms, and sanctions those who do not. The women’s experiences further reveal that their decisions often “cut both ways.” These women’s decisions “cut both ways,” because while the women acquired personal benefits, these came with significant physical and emotional costs. Finally, it “cuts both ways,” because while these women personally benefited, their decisions result in the reproduction of the current beauty system and uphold the unjust feminine beauty norms on which it is based. / viii, 228 leaves ; 29 cm.

INTRODUÇÃO: Pacientes portadoras de obesidade mórbida submetidas a tratamento cirúrgico através de cirurgias disabsortivas-restritivas, após considerável perda ponderal, evoluem com dobras cutâneas ou dermogordurosas em várias regiões do corpo. As mamas são caracterizadas pela deficiência de volume, ptose acentuada, assimetria e medialização dos complexos aréolo-papilares. A mastopexia com inclusão de implantes mamários tem demonstrado ser solução cirúrgica eficaz para melhora da forma, volume e simetria das mamas. OBJETIVO: Avaliar a satisfação das pacientes e os resultados cirúrgicos obtidos após a mastopexia com inclusão de implantes mamários. MÉTODOS: Vinte pacientes do sexo feminino, com média etária de 39,9 anos, foram submetidas à mastopexia com inclusão de implantes mamários entre setembro de 2008 e abril de 2009. Foram aplicadas entrevistas psicológicas semidirigidas a todas as pacientes, nos períodos pré e pós-operatórios, cujas respostas foram tabuladas, divididas em categorias, e possibilitaram a avaliação da satisfação das pacientes. Foi realizada avaliação dos resultados cirúrgicos através da análise fotográfica por três cirurgiões plásticos independentes, nos períodos pré e pós-operatórios, onde foram atribuídas notas zero, um ou dois, para os seguintes itens: forma da mama, volume da mama, simetria entre as mamas, posicionamento do complexo aréolo-papilar e qualidade e extensão das cicatrizes. RESULTADOS: Dezenove pacientes (95%) referiram satisfação com o resultado cirúrgico obtido (p<0,001). Quatro pacientes (20%) relataram melhora da vida profissional; doze pacientes (60%), melhora da vida social; dez pacientes (50%), da vida afetiva; e dez pacientes (50%), da vida sexual. A média das somatórias das notas atribuídas pelos três cirurgiões, referentes a cada paciente, variou entre 4,7 e 10, sendo a média geral de 7,28. Os resultados foram considerados bom ou ótimo para 65% da amostra e pobre para 8,4%. CONCLUSÕES: Houve satisfação de 95% das pacientes com os resultados obtidos pela mastopexia com inclusão de implantes. A análise fotográfica dos resultados obteve nota média de 7,28, caracterizado como bom resultado, apesar da fraca concordância entre os avaliadores. / INTRODUCTION: Morbid obesity patients submitted to surgical treatment through disabsortive-restrictive procedures, and after considerable weight loss, develop skin or fatty tissue folds in many regions of the body. These changes in the breasts, in particular, are characterized by volume deficiency, marked ptosis, asymmetry and medialization of the nipple-areola complexes (NAC). Mastopexy associated with breast implant inclusion has shown to be an efficient solution to improve shape, volume and breast symmetry. OBJECTIVE: To evaluate patient satisfaction and surgical results obtained after mastopexy with breast implant inclusion. METHODS: Twenty female patients with a mean age of 39.9 years were submitted to mastopexy with breast implant inclusion between September 2008 and April 2009. All patients had semi-directed psychological evaluation in the pre- and postoperative periods. The answers to the evaluations were tabulated, categorized, and allowed patient satisfaction analysis. The surgical results evaluation was made through photographic analysis of three independent plastic surgeons, in the pre- and post-operative periods, when scores of zero, one or two, were attributed to the following items: breast shape, breast volume, symmetry of breasts, NAC position, scar quality and extent. RESULTS: Nineteen patients (95%) referred satisfaction with the surgical results attained (p<0,001). Four patients (20%) referred improvement in their professional lives; twelve patients (60%), improvement in their social lives; ten patients (50%), of their affective lives; and ten (50%) of their sexual lives. The mean sum of the scores attributed by the three surgeons, respective to each patient, varied between 4.7 and 10, with an overall mean of 7.28. The results were considered good or great for 65% of the sample and poor for 8.4%. CONCLUSIONS: There was a 95% satisfaction rate among patients with the results obtained through Mastopexy with breast implant inclusion. The photographic analysis of the results obtained a mean score of 7.28, considered as a good result, albeit the weak correlation among evaluators.