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The reconstructive and aesthetic breast surgery is a major breakthrough for the treatment of women fighting cancer. An advantage for the patient is the reduction of surgical treatment to one professional, besides the psychological and aesthetic relief of having her breast comfortably reconstructed by the doctor who is already accompanying her in the treatment of the disease. Considering the advances in oncological breast surgery, fhe ideal surgical procedure is one that achieves local control of the disease by maintaining the symmetry of the breast with immediate reconstruction. Plastic surgery techniques can be used in breast cancer surgery. The original focus is on improving the quality of life of oncological patients undergoing treatments that may be more effective in the aesthetic and functional point of view from the perspective of traditional techniques of breast conservation. Formation and training of professionals able to treat breast cancer is an innovative concept that brings discussions to the scientific community. Specific studies are required to standardize oncoplastic training. Training in reconstructive and aesthetic breast surgery also brings about new perspectives of surgical research related to aesthetic results, quality of life and local control, as well as the optimization of operative time, reducing adverse effects and costs. This study aimed to evaluate the main existing techniques, the training time for specialization in the context of Brazilian reality and whether it is necessary to change the current training model. This review is based on the conviction shown in other publishing studies (in press), which demonstrate the best way and the best work load for the improvement of the mastologist regarding oncoplastic and reconstructive breast surgeries.

Os bancos de dados disponíveis na internet são importantes fontes que viabilizam a promoção do conhecimento em saúde. Objetivo: Identificar a produção científica de mastologistas brasileiros acerca do tema cirurgia oncoplástica e reconstrutiva da mama, publicado entre janeiro de 2000 e março de 2016 nas bases de dados LILACS, MedLine, SciELO, PubMed e Cochrane Library. Métodos: As publicações identificadas foram analisadas a partir de uma perspectiva bibliométrica, sendo discriminados alguns elementos, tais como tipo de publicação, metodologia aplicada, ano de publicação, número de citações do trabalho, classificação Qualis do periódico de veiculação do trabalho, número e perfil profissional dos autores, bem como a instituição de desenvolvimento das publicações. Resultados: Foram analisados 631 trabalhos publicados nos referidos bancos de dados, sendo incluídas para avaliação final dos parâmetros bibliométricos 76 publicações. Mais da metade das publicações avaliadas foram provenientes do banco de dados PubMed (78,94%) e eram artigos originais (57,89% RESUMO ABSTRACTDatabases available on the Internet are important sources that enable the promotion of knowledge in the health field. Objective: To identify the scientific production of Brazilian mastologists on the subject of oncoplastic and reconstructive breast surgery published between January of 2000 and March of 2016, in the LILACS, MedLine, SciELO, PubMed and Cochrane Library databases. Methods: The identified publications were analyzed from a bibliometric perspective, and some elements such as type of publication, applied methodology, year of publication, number of job citations, Qualis ranking of the journal, number and professional profile of the authors, in addition to the publication development institution were separated and categorized. Results: A total of 631 published papers were analyzed in these databases. 76 publications were included in the final evaluation of bibliometric parameters. More than half of the evaluated publications were from the PubMed database (78.94%) and were original articles (57.89%). The average number of authors per article was 8.48. The largest number of publications included came from the year 2012 (14.47%) followed by 2013 (13.15%) and 2015 (11.84%).A significant percentage of Qualis rated journals were considered very good (A1, A2 or B1). Conclusion: The results show an evolution and an upward trend regarding the participation of Brazilian mastologist authors in national and international scientific productions related to oncoplastic and reconstructive breast surgery.

Introduction: Conserving surgery in the treatment of breast cancer, in association with radiotherapy, has replaced mastectomy in most cases. However, depending on the location and size of tumor, the classic conservative surgery can present unfavourable aesthetic results and high levels of commitment of the surgical margins. The oncoplastic breast surgery can have high local control rates and cause minimum breast deformities, leading to a better aesthetic result. Objective: To report cases of 30 patients with primary unilateral breast carcinoma who underwent oncoplastic surgery between 2013 and 2015. Methods: We used local and regional dermo-glandular rotation techniques. The average age of patients was 58.9 years. The average tumor size was 2.53 cm. Three patients had close or positive surgical margins and underwent a new surgical procedure. Results: The aesthetic result was evaluated by the BCCT.core program and was considered excellent in 11 cases, good in 12 cases and regular in 7 cases. Six patients had postoperative complications. Conclusion: The use of local and regional dermo-glandular rotation techniques allows extensive resections in breast conserving surgery, leading to a satisfying symmetry and a good aesthetic result without the need of symmetrization, with low postoperative complication rates and high rates of free surgical margins.KEYWORDS: Breast cancer; breast reconstruction; surgical flaps; surgical margins; cosmetic techniques. ABSTRACT RESUMOIntrodução: A cirurgia conservadora no tratamento do câncer de mama, associada à radioterapia, tem substituído a mastectomia na maioria dos casos. Entretanto, dependendo da localização e do tamanho do tumor, a cirurgia conservadora clássica pode resultar em um resultado estético insatisfatório e em altos índices de comprometimento de margens cirúrgicas. A cirurgia oncoplástica da mama pode apresentar altas taxas de controle local, causando deformidades mamárias mínimas, levando a um melhor resultado estético. Objetivo: Relatar casos de 30 pacientes com carcinoma mamário unilateral que foram submetidas à cirurgia oncoplástica da mama entre 2013 e 2015. Métodos: Foram utilizadas técnicas de rotação dermoglandular local e regional. A idade média das pacientes foi de 58,9 anos. O tamanho médio do tumor foi 2,53 cm. Três pacientes apresentaram margens cirúrgicas exíguas ou comprometidas, sendo submetidas a novo procedimento cirúrgico. Resultados: O resultado estético foi avaliado pelo programa BCCT.core, sendo considerado excelente em 11 casos, bom em 12 casos e regular em 7 casos. Seis pacientes apresentaram complicações pós-operatórias. Conclusão: A utilização de técnicas de rotação dermoglandular local e regional permite ressecções extensas na cirurgia conservadora da mama, permitindo uma simetria satisfatória e um bom resultado estético sem a necessidade de simetrização, com baixos índices de complicação pós-operatória e altas taxas de margens cirúrgicas livres.

Introduction: Gynecomastia (GM) is a benign proliferation of glandular breast tissue in men. Some cases need surgical intervention. Traditional open surgery by semicircular inferior periareolar incision is the most common surgical approach. In order to obtain better esthetic results, some alternatives to open surgery have been proposed, such as liposuction, endoscopic mastectomy, and vacuum-assisted excision (VAE). Objective: To describe the technical surgical approach of ultrasound-guided VAE of GM and its results from a case series. Method: This is an evaluation of seven GM cases submitted to ultrasound-guided VAE with a 10G needle using the ENCOR® BD whole circumference automated breast biopsy system in Redimasto – Redimama, a Brazilian breast center. The result was considered good or satisfactory when it showed minimal remaining gland, good symmetry, no retraction, necrosis, hypertrophic scar, or displacement of the nipple-areola complex. All patients answered a questionnaire to evaluate their satisfaction and perception of the procedure. Results: Seven (7) patients with Simon grade 1 and 2 bilateral GM underwent ultrasound-guided VAE. No case of displacement, necrosis, or retraction of the nipple-areola complex, post-procedure bleeding, infection, skin necrosis, or asymmetry was detected. No patient reported decrease or change in nipple sensation or erection. All patients had bruises and hematomas that spontaneously resolved within 30 days. All results were considered good or excellent by patients and surgeons. Conclusion: Minimally invasive ultrasound-guided VAE is an excellent alternative for the treatment of GM. It is better indicated for Simon grade 1 and 2 GM, with good and excellent esthetic results, small scar, and low rates of nipple and areolar complications. It allows an outpatient procedure with low morbidity (local anesthesia) and fast recovery.

Introdução: O câncer de mama é a neoplasia maligna mais prevalente em mulheres. Em decorrência do diagnóstico tardio, a mastectomia radical modificada permanece como o tratamento cirúrgico de escolha para grande parte das pacientes portadoras da doença. A reconstrução mamária com retalhos miocutâneos apresenta os melhores resultados em longo prazo. A técnica do TRAM foi aperfeiçoada nos últimos 30 anos e tem como principal vantagem a utilização de grandes volumes, dando à nova mama contorno e consistência mais naturais. Objetivo: Revisar a literatura a respeito da técnica de reconstrução com o TRAM, enfocando as indicações da técnica, a seleção de pacientes e suas principais complicações. Resultados: As principais indicações da reconstrução com TRAM referem-se a casos de defeitos extensos após mastectomia imediata ou tardiamente, ou quando existem sequelas importantes de radioterapia ou falha em outras reconstruções, devendo-se ter critérios rigorosos na seleção dessas pacientes, principalmente no que diz respeito às suas comorbidades. A adequada seleção de pacientes pode reduzir uma série de complicações advindas do método. Conclusão: O TRAM é uma excelente opção para a reconstrução mamária imediata ou tardia, desde que as pacientes sejam bem selecionadas; elimina (ou, pelo menos, reduz) a necessidade de implantes e suas possíveis implicações, além de dar formato mais natural à mama reconstruída, acompanhando as flutuações de peso da paciente. Entretanto, essa técnica não está isenta de complicações, principalmente na área doadora, além de demandar tempo cirúrgico e de recuperação maiores.

Introdução: A cirurgia conservadora da mama tem se modificado consideravelmente nas últimas décadas. O remodelamento mamário pós-cirurgia conservadora apresenta-se como uma forma de abordagem cirúrgica com bons resultados oncológicos e cosméticos. A margem cirúrgica das cirurgias oncológicas da mama tem se mostrado um fator limitante, pois um percentual considerável das pacientes é submetido a novos procedimentos, aumentando os custos e a morbidade. Objetivo: Descrever a experiência da instituição de ampliação sistemática das margens cirúrgicas na cirurgia conservadora de mama e os benefícios dessa técnica. Métodos: Estudo retrospectivo, que avaliou informações contidas em prontuário de pacientes do Instituto de Mama de Campinas, entre os anos de 2009 e 2015. A ampliação sistemática das margens consiste na retirada de tecido em torno do tumor, com espessura de 1 cm e dimensões de 2 cm nos demais eixos. São avaliadas margens medial, lateral, cranial, inferior, profunda e superficial. Resultados: Em um total de 94 casos com realização de ampliação sistemática das margens cirúrgicas, foram evitadas 18 (20%) reoperações. Apenas duas pacientes necessitaram de nova cirurgia. Conclusão: Trata-se de um procedimento simples e reprodutível, que não prejudica o resultado estético final, e que visa oferecer margens cirúrgicas livres de doença, evitando a reoperação e o atraso do tratamento adjuvante. PALAVRAS-CHAVE:Neoplasia da mama; margens de excisão; mamoplastia. RESUMO ABSTRACTIntroduction: Conservative breast surgery has changed considerably in recent decades. Breast remodeling after conservative surgery is a surgical approach that has good oncological and cosmetic results. The surgical margin of oncological breast surgery has been shown to be a limiting factor, because a considerable percentage of patients undergo additional procedures, which increases costs and morbidity. Objective: To describe the experience of the establishment of systematic cavity shaving in conservative breast surgery and the benefits of this technique. Methods: This is a retrospective study, which evaluated information contained in patient records at the Campinas Breast Institute between 2009 and 2015. Systematic cavity shaving consists of the removal of tissue around the tumor in a thickness of 1 cm, and 2 cm in the other axes. Medial, lateral, cranial, inferior, deep and superficial margins are evaluated. Results: In a total of 94 cases with systematic cavity shaving, 18 (20%) reoperations were avoided. Only two patients required further surgery. Conclusion: It is a simple and reproducible procedure, which does not affect the final aesthetic result, and aims to provide disease-free surgical margins, avoiding reoperation and delayed adjuvant treatment.

Objective: The aim of this study was to evaluate vacuum-assisted excision (VAE) for percutaneous treatment of breast cancers. Methods: This is a retrospective analysis of 1061 vacuum-assisted biopsies (VAB) and VAE for the diagnostic purpose of suspicious breast lesions in a breast unit between April 13, 2017 and November 28, 2020. In total, 116 cases with complete data from VAB/VAE and surgical excision were evaluated. Excision following VAB/VAE was defined as complete resection (CR) if there was no residual tumor, minimal residual disease (MRD) if residual tumor was ≤3 mm, gross residual disease (GRD) if residual tumor was ≥3 mm, and upgrade from DCIS on VAB/VAE to invasive cancer. CR and MRD were combined as potentially resected and treated percutaneously (PRTP). The GRD and those with an upgrade to invasion were determined not suitable for percutaneous treatment. Results: The median age was 55.6 years (20–91; SD 12.27), and the median tumor size on imaging was 11.6 mm (4–88; SD 10.59). Of the 116 tumors, 29 (25%) were CR, 18 (15.5%) were MRD, 64 (55.2%) were GRD, and 5 (4.3%) were upgraded from DCIS to invasion. There were 47 (40.5%) tumors that were PRTP, of which 10 (21.3%) were DCIS and 37 (78.7%) were invasive diseases (12 pure invasive carcinoma [IC], 24 IC + DCIS, and 1 DCIS with microinvasion). In multivariate analysis, a VAE procedure (p=0.008, odds ratio [OR]: 4.4, 95%CI) with low/intermediate nuclear grade (p=0.000, OR: 12.5, 95%CI) and final T≤10 mm (p=0.000, OR: 50.1, 95%CI) were associated with PRTP. In this retrospective analysis, the probability of PRTP of low/intermediate grade tumors smaller than 10 mm undergoing VAE was 84.58%. Conclusion: These data suggest that low/intermediate grade pT1a/b breast tumors can be completely excised with percutaneous VAE. Based on this, small (≤10 mm) IC of low/intermediate grade could be considered for entry to prospective randomized trials of VAE for local treatment, with a long-term follow-up to assess recurrence rates. Standardization of the procedure should be recommended.