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Secanho MS, Cintra W, Carneiro IC, Alves GFF, Gemperli R. Access to reconstructive plastic surgery for patients undergoing bariatric surgery in the Unified Health System (SUS). Rev Col Bras Cir 2023; 50:e20233520. [PMID: 37531503 PMCID: PMC10508680 DOI: 10.1590/0100-6991e-20233520-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/29/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system - Sistema Único de Sáude (SUS) - provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database. METHODS in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant. RESULTS a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries. CONCLUSIONS Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .
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Affiliation(s)
- Murilo Sgarbi Secanho
- - Hospital das Clínicas da Universidade de São Paulo (USP), Disciplina de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Wilson Cintra
- - Hospital das Clínicas da Universidade de São Paulo (USP), Disciplina de Cirurgia Plástica - São Paulo - SP - Brasil
| | - Igor Castro Carneiro
- - Hospital das Clínicas da Universidade de São Paulo (USP), Disciplina de Cirurgia Plástica - São Paulo - SP - Brasil
| | | | - Rolf Gemperli
- - Hospital das Clínicas da Universidade de São Paulo (USP), Disciplina de Cirurgia Plástica - São Paulo - SP - Brasil
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Modolin MLA, Camargo CP, Milcheski DA, Cintra W, Rocha RI, Clivatti GM, Nascimento B, Gemperli R. Castleman disease. Interaction with dermatopathy: Case report. Int J Surg Case Rep 2020; 73:332-337. [PMID: 32739521 PMCID: PMC7393987 DOI: 10.1016/j.ijscr.2020.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Castleman disease (CD) is a lymphoproliferative disorder with lymph node hypertrophy. In the unicentric form (UCD), it affects one lymph node or chain of lymph nodes. In the multicentric form (DCM), there is hypertrophy of several lymph node chains with the formation of tumor masses, causing compressive symptoms. This case report showed a case of CD in a different location(inguinal region) associated to a multiple skin lesions. PRESENTATION OF THE CASE We reported a UCD in a 43-year-old female patient with no previous comorbidities. Since January 2016, this patient developed erysipelas lesions of the left leg (LL) from the thigh root to the foot. Concomitantly, a tumor mass appeared in the inguinal region. In 2019 we performed a biopsy that revealed changes characteristic of CD. Due to extremely poor trophic conditions, the skin area with erysipelas was resected, and the raw surface was grafted. DISCUSSION As an inference, the erysipelas may have been responsible for the subsequent lymphangitis, lymphedema and lymph node hypertrophy. CONCLUSION Resection of the diseased skin and lymph node excision constitute the treatment of UCD and result in improvement of the clinical picture. Nevertheless, further study of the inflammatory reaction and of markers such as interleukin-6 and the presence of skin disorders in DC is needed.
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Affiliation(s)
- M L A Modolin
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - C P Camargo
- Laboratório de investigação médica - LIM-4- School of Medicine, Universidade de São Paulo, Brazil.
| | - D A Milcheski
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - W Cintra
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - R I Rocha
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - G M Clivatti
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - B Nascimento
- Universidade de São Paulo - Hospital das Clínicas, School of Medicine Universidade de São Paulo, Brazil
| | - R Gemperli
- School of Medicine Universidade de São Paulo, Brazil
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Modolin MLA, Cintra W, Rocha RI, Camargo CP, Giuliani NDR, Souza HPD, Barbeiro HV, Gemperli R. Analysis of inflammatory and metabolic biomarkers in patients submitted to abdominoplasty after bariatric surgery. Acta Cir Bras 2019; 34:e201900506. [PMID: 31166465 PMCID: PMC6583934 DOI: 10.1590/s0102-865020190050000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/12/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose: To evaluate the serum variations of Interleukins (Il) and CPR of abdominoplasties in post-bariatric patients and, to equate the homeostasis (HOMA) from the variations of glycemia and insulin to evolute the metabolic modifications. Methods: Fourteen women were submitted to abdominoplasties with weight loss after a gastroplasty. Levels of IL4, IL6, IL10, CRP, glycemia and insulin were obtained during the pre-operative, trans-operative, 24 hours post, 7th and 14th postoperative days. Results: The IL4 was higher at 24 hours post-surgery, and after a moderate decrease, it remained high until the 14th day. The IL6 and CRP had an expressive increase during the trans-operative period. The CRP remained high, and the IL6 decreased on the 7th and 14th days. The IL10 increased during the transoperative period, and it posteriorly decreased to lower levels in comparison to the pre-operative period. The already increased glycemia during the pre-operative period was even higher during the trans-operative and then, returned to preliminary values on the 7th and 14th days after surgery. The HOMA accompanied the insulin. Conclusion: The inflammatory and glycemic serum levels decrease after abdominiplasty in obese post-bariatric patients.
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Affiliation(s)
| | - Wilson Cintra
- Clinics Hospital, Medical School, USP, São Paulo, SP, Brazil
| | | | | | | | | | | | - Rolf Gemperli
- Clinics Hospital, Medical School, USP, São Paulo, SP, Brazil
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Abstract
In a prospective study, indices of glucose homeostasis, lipid profile, and systemic inflammation were monitored after an aesthetic abdominoplasty, aiming to scrutinize the possible metabolic benefits for abdominal fat removal. Premenopausal females with substantial weight loss (N=40) undergoing circumferential abdominoplasty (index group, n=20) or augmentation mammoplasty with mastopexy (controls, n=20) were recruited. All of them originally underwent Roux-en-Y gastric bypass. Variables included BMI, white blood cell count, C-reactive protein, hemoglobin, total cholesterol and fractions, triglycerides, glucose, and HbA1c. Follow-up reached 20.3 ± 13.6 months for index cases and 29.5 ± 17.4 months for controls. The metabolic and inflammatory indices improved after the bariatric surgery. Subsequent monitoring indicated a stable body weight and biochemical profile in both groups. The exceptions were HDL cholesterol and C-reactive protein, which respectively increased and diminished after the abdominoplasty, consistent with an inflammatory and metabolic advantage for this operation. This is the first long-term study in a weight-stable population to point out such a pattern after abdominoplasty.
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Affiliation(s)
- Wilson Cintra
- Plastic Surgery Service, Hospital das Clinicas, Sao Paulo, Sao Paulo, 05403-900, Brazil
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Marques M, Modolin M, Cintra W, Gemperli R, Ferreira MC. Monsplasty for women after massive weight loss. Aesthetic Plast Surg 2012; 36:511-6. [PMID: 22258835 DOI: 10.1007/s00266-011-9859-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/09/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Ptosis with excess skin in the pubic area is a very common deformity in patients after massive weight loss. This deformity requires adequate surgical treatment whether combined with abdominoplasty or not. The enlarged pubogenital area may lead to psychosocial distress and impaired quality of life. METHODS A series of 23 women with a mean age of 39.5 years who previously underwent bariatric surgeries and later presented with pubogenital ptosis underwent monsplasty. The preoperative surgical markings and the surgical technique presented are easily reproducible. In this prospective study, the surgical outcomes were assessed by questionnaires applied to the patients, who scored the following parameters: movement dynamics, aesthetic appearance, sexual performance, improved hygiene, and use of clothing items. RESULTS Four of the parameters assessed (movement dynamics, aesthetic appearance, hygiene, and use of clothing items) showed clear improvement, with scores ranging from good to very good. A small percentage of the patients (13%) reported fair improvement in sexual performance. CONCLUSION The findings showed monsplasty to be a simple and reproducible technique with favorable outcomes and low morbidity rates. 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 at www.springer.com/00266.
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Affiliation(s)
- Maíra Marques
- Division of Plastic Surgery, University of Sao Paulo School of Medicine, Av. São Gabriel, 201, cj. 704/5, São Paulo, 01435-001, Brazil
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Modolin ML, Cintra W, Faintuch J, Silva MM, Moraes LB, Gemperli R, Ferreira MC. Improved double-fuse technique for post-bariatric brachioplasty. Rev Col Bras Cir 2012; 38:217-22. [PMID: 21971853 DOI: 10.1590/s0100-69912011000400003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 10/26/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the use of modified brachioplasty, investigating in late postoperative complications and satisfaction with the outcome, in women previously submitted to bariatric surgery. METHODS The population (N = 18, age 49.2 ± 11.3 years), which had undergone brachioplasty 25.2 ± 11.9 months after the bariatric procedure, was contacted after 31.7 ± 38.8 additional months. Surgical complications and satisfaction with the operation were estimated by interviews, including a questionnaire designed for this purpose. RESULTS pre-bariatric body mass index (BMI) was 57.1 ± 11.1 kg / m(2), being 28.3 ± 6.0 kg/m(2) before the brachioplasty, without significant changes thereafter. Three minor surgical complications were recorded (3 / 18, 16.7%), namely, temporary paresthesia, seroma and small imperfection of the scar. The satisfaction rate was approximately 90%, with the three most rewarding results for the patients being the ease of dressing (P = 0.01), decreased weight of the arm (P = 0.03) and absence of edema (P = 0.04). There was a negative correlation between severe weight loss and degree of satisfaction, however, no patients regretted the procedure. CONCLUSION the modified brachioplasty was successful in cases with severe brachial ptosis with possible extension to the chest. The study confirmed functional and aesthetic benefits, and thanks to the technique applied, most of the complications and disappointments could be avoided.
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Affiliation(s)
- Miguel L Modolin
- Department of Plastic Surgery, Faculty of Medicine, University of Sao Paulo, Brazil.
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Modolin M, Cintra W, Silva MM, Ribeiro L, Gemperli R, Ferreira MC. Mammaplasty with inferior pedicle flap after massive weight loss. Aesthetic Plast Surg 2010; 34:596-602. [PMID: 20428869 DOI: 10.1007/s00266-010-9516-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Accepted: 03/22/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND After massive weight loss, one of the stigmas that afflict women is the remaining deformity of the breasts which become flaccid and ptotic, with an absent or flat upper pole. The authors propose the use of a well-established mammaplasty technique to fill the upper pole, reshape the breast cone, and correct ptosis with nipple-areola complex (NAC) repositioning. METHODS A total of 16 patients were analyzed; all underwent gastroplasty between 18 and 24 months prior to mammaplasty. The mean age was 41.6 years (range = 26-62) and the mean BMI previous to the mammaplasty was 29.2 kg/m(2) (range = 24.9-38.9). The technique included a dermo-lipo glandular flap pedicled on the inframammary fold (IMF) together with a superior flap containing the NAC. RESULTS All patients who underwent surgery were satisfied with the outcomes since a more aesthetic breast shape was achieved, with projection of the upper pole and correction of ptosis. Adverse events included dehiscence at the junction point of the flaps in the inframammary fold, which resolved with secondary-intention wound healing in three patients; partial necrosis of the areola in one patient; epidermolysis in one of the NACs in one patient; and infection in one of the breasts in one patient, which resolved with proper antibiotic therapy. CONCLUSION When compared to the current mammaplasty techniques performed in formerly obese patients, this is a good surgical option because it uses tissues adjacent to the breast itself and does not require silicone prosthesis for breast augmentation. The patients reported increased self-esteem and improvement in their quality of life.
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Affiliation(s)
- Miguel Modolin
- Division of Plastic Surgery, University of São Paulo School of Medicine, Rua Canadá, 89, São Paulo, SP, 01436-000, Brazil.
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Cintra W, Modolin MLA, Gemperli R, Gobbi CIC, Faintuch J, Ferreira MC. Quality of Life After Abdominoplasty in Women After Bariatric Surgery. Obes Surg 2008; 18:728-32. [DOI: 10.1007/s11695-007-9280-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 07/08/2007] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Mild lymphedema of lower limbs and eventually abdomen is not exceedingly rare in morbid obesity. However, few large symptomatic masses have been reported. In a consecutive series of patients, all requiring resection of the lesion before bariatric treatment, clinical features and surgical findings are described, aiming to clarify the nature of this intricate problem. METHODS Subjects (n=4, 50% females, age 34.0+/-13.7 years (19-53), BMI 56.4+/-10.5 kg/m(2) (44.1-73.1) displayed lesions on the anteromedial aspect of the thigh (n=3) and hypogastrium (n=1). All reported episodes of intertrigo of local skin-folds in the preceding years, managed by local care and antibiotics. The mass was described as a serious nuisance, impairing walking, dressing and personal hygiene. RESULTS The mass was surgically removed without requirement for blood transfusion except in the case of one huge mass. Complications were relatively minor and consisted of partial skin dehiscence and lymph leakage for 2-3 weeks. Histologically, a complex pattern was observed including skin hypertrophy, edema, fibrosis, foci of microabscesses and dilated blood vessels, along with the pathognomonic lymphangiectasia. On follow-up to 6 months, improvement or restoration of the ability to walk occurred, with no additional skin infection and no recurrence. CONCLUSIONS 1) Surgical treatment was effective. 2) Functional rehabilitation was achieved. 3) No recurrence was observed within the follow-up period.
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Modolin M, Mitre AI, da Silva JCF, Cintra W, Quagliano AP, Arap S, Ferreira MC. Surgical treatment of lymphedema of the penis and scrotum. Clinics (Sao Paulo) 2006; 61:289-94. [PMID: 16924318 DOI: 10.1590/s1807-59322006000400003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Accepted: 05/03/2006] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. MATERIALS AND METHODS Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. RESULTS Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. CONCLUSIONS The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.
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Affiliation(s)
- Miguel Modolin
- Plastic Surgery/Urology Faculty of Medicine, University of São Paulo.
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Abstract
UNLABELLED Patients with unilateral cleft lip display characteristic nasal changes that are independent of the degree of deformity. Defenders of the intrinsic theory consider these deformities to be due to embryogenic alterations of the alar nasal cartilages. Those that propose the extrinsic theory defend the thesis that the deformity is due to disorganization of the perioral muscles deformed by the cleft. The purpose of this study is to contribute histological evidence to help clarify the issue. PATIENTS AND METHODS Specimens of the lateral portion of both the healthy and the cleft side of the alar cartilages were obtained from 18 patients. These uniformly cut specimens were stained by hematoxylin and eosin. Samples from 2 patients were excluded due to imperfections. The same pathologist examined all the slides. He was unaware of the origins of the specimens; he counted the number of chondrocytes and quantified the cartilage matrixes. RESULTS All data was analyzed statistically, and no significant statistical differences were apparent, either in the number of chondrocytes or the cartilage matrix between the healthy side and the cleft side. DISCUSSION These results apparently support the group that defend the extrinsic theory; nevertheless, the doubt about the composition of the cartilage matrix remains, not only concerning the glycosaminoglycans that compose them, but also regarding elastin and collagen and its linkages that can cause different degrees of collagen consistency.
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Affiliation(s)
- Miguel Modolin
- Division of Plastic Surgery, Hospital das Clínicas, Faculty of Medicine, University of São Paulo
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Abstract
BACKGROUND The severely obese patient, after considerable loss of weight, has large remaining skin folds. Classic transverse abdominoplasties leave bulges in the flanks. This article presents an alternative procedure, circumferential abdominoplasty, which involves the perimeter of the abdomen. METHODS Average age of the patients was 39.5 years, consisting of 10 females and two males. Incisions were made like those of the classic transverse abdominoplasty, but were extended dorsally without tension on the suture-line. RESULTS Pre and postoperative aspects revealed the huge impact achieved after resection of the excess panniculus, with improvement of body contour, posture, ambulation, social and psychological integration, hygiene and sexual performance. In some patients, seromas, partial dehiscences, flap infection and atelectasis were immediate complications. Hypertrophic scars and some remaining skin folds were late complications. CONCLUSION The major disadvantage of the circumferential abdominoplasty is the resulting scar. However, this procedure should be taken into consideration as an option to achieve a more harmonious body contour. Complications are not enough to contraindicate the surgery, because the patients preferred better social and professional integration, as well as behavioral improvement due to enhancement in their self-confidence.
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Affiliation(s)
- Miguel Modolin
- Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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