The amputation of a breast for tumor reasons is very common (the breast tumor in women is, overall, the the most incidence), a status which is a major psychological damage, emotional shock and serious disturbance. Currently, thanks to the great advances in medicine it is possible to rebuild what was lost with the intention of returning to the patient the joy and motivation, often lost in this stage of life.
A woman’s breast, besides being an important functional organ, is in the perspective of today’s society, an integral and identifying of the female contour. This structure has a strong bond with psychological, social, professional and sexual life, whether to the woman as for the man. Being a part of the body where the newborn comes into direct contact earlier, linked to their survival, it receives the symbolic expression of femininity of Greek Art.
The plastic surgeon is most often sought in order to proceed with corrective and artistic sculpture of breasts in the following situations: small breast (mammary hypoplasia and atrophy) big breast (breast hypertrophy and gigantism) breast sag (ptosis) different breasts (breast asymmetry) breast (status post-mastectomy) and enlargement of the male breast (gynecomastia).
Surgical interventions are implemented after the adequated programming to the patient clinical study, laboratory study (analysis of the blood and urine), electrocardiogram if necessary and other diagnostic procedures, appropriate to the case.
Following this assessment it should be given very importance to the psychological profile and the patient’s subjective claims about the volume, shape, projection and other details of the breast With this global knowledge of the patient and meticulous about his desire, it is scheduled a surgical repair, most often under general anaesthesia.
The history of the human being has shown that he still values his integrity more or particular organ when there is a risk of losing it. After breast, mostly for oncological reasons, the prospect of rebuilding offers joy of life to the patients. Through clinical situations, reconstruction can be immediate or delayed a few months or few years, given that the contraindications for this interventions are restricted, and the suffering and morbidity after breast reconstruction is very small.
In my case, I like younger patients to whom was held breast reconstruction, a girl with 17 years old and older lady of 68 years. However is more frequent between 30 and 40 years old.
Usually, the reconstruction is processed in two separate interventions of a few months (2-6 months)having multiple plastic surgery techniques for the same purpose, the surgeon must judiciously select them. The most commonly used these days consists of inserting a expansive prosthesis, also called expander (bag empty silastic), under the skin in the region (“pregnancy spot”) to the desired size and volume with the introduction of regular saline through the valve itself.
After this time, we proceed to the breast symmetry, decreasing or increasing the other breast and reconstituting the board of the new mammillary-areola breast with the excess taken from the other side. It can also be used other pigmented skin areas of the body or it can be made a tattoo.
The results, besides being durable are very rewarding, having to register sometimes the scar less aesthetic relating to the mammary amputation and whose location does not favor its disguise.
In other cases, reconstruction is indicated with the patient’s own tissues, and it may not have the resource to this technique of expansion. In this situation, one may use the set of tissues, skin, fat, muscle and below the belly button, which are transferred into the amputated region with its own vitality. Thus, it is possible to reconstruct ( “from scratch”) immediately, ie as soon as the breast is amputatedor in a delayed form- that is months or years after surgery mutilating.
In all cases, it is important that women know that currently the major technological advances allow for a satisfying breast reconstruction and rewarding, in terms of morphological functional, social sexual and psychological factors, contributing to the patient’s emotional balance.
by Z. Biscaia Fraga
[/toggle] [toggle title=”Teeth”]The Prognathism characterizes itself by an increase of the projection of the anterior mandible, that is, the person has a much lower jaw and projected out to the front. This was a common feature among the nobles. Some call it even the Habsburg jaw, due to the prevalence of this manifestation in the European royal family, caused by the large number of consanguineous marriages. The prognathism interferes functionally with chewing and dental articulation because the upper teeth do not fit in the bottom.
It is a problem that causes major constraints in the life of the individual, both functional and, above all, aesthetics. Not only by changing the articulated dental itself (open bite or occlusion bottom) but also of the profile of face (concave face), increasing the vertical dimension of the face.
It begins to reveal itself in childhood and increases dramatically during adolescence. The most effective way to correct the prognathism is through surgery (it is difficult to solve this problem through other treatments) and the ideal time to do it is from the age of 17. Some people take time to decide for this surgery, but its benefits are significant and provide a more harmonious face.
[/toggle][toggle title=”Face”]Facial paralysis occurs when there is a paralysis of some or of all the muscles responsible for facial movements and expressions. It is the nerve, referred to as facial, which controls the muscles of the face as well as being responsible for the sense of taste in anterior 2/3 of the language and to participate in the secretion of saliva and tears.
Facial paralysis can be central, as in cases of AVC (cerebrovascular accident) or peripheral as in trauma and viral infections. This causes a major anxiety in the patient, since the idea that immediately arises is associated with a stroke. However, over 70% of cases are caused by a less severe disease, called Bell Palsy.
This is a facial paralysis caused by simplex herpes virus, the same that causes labial and genital herpes . This virus can attack the facial nerve causing it to become inflamed and swollen. This turns out to compress it into the bones of the skull, reducing its ability to transmit nervous impulses.
Among the risk factors suffer from Bell Palsy are in the third trimester pregnancy and diabetes mellitus. This palsy starts abruptly with the paralysis of half of the entire face. The most common symptoms are loss of expression in half of the face, with inability to fully close one eye raising a brow to frown and smile. In addition, other associated symptoms: diminished tearing of the eyes, increased sensitivity to sound in one ear, reduced taste in 2/3 of the original language, decreased salivation, and headache or around the jaw.
Bell’s Palsy usually regress spontaneously. In more aggressive cases that don’t show improvement after 21 days, it can leave sequels.
[/toggle][toggle title=”Genitals”] Hypospadias is an abnormal change in the development of the male urethra. The urethra may end at any point in the ventral part of the penis from the glans to the perineum (in most severe cases). As a result, and due to this cessation of urethral grown, the penis acquires other malformations since the spongy body up to the foreskin, is usually typical in these cases. We can have a penile curvature associated with changes in the scrotum and even the testicles.The complexity of this disorder is variable. Surgery is the only solution because it is necessary to reconstruct the urethra. For this, we use a graft derived from any mucosa of the patient. This intervention takes place after six months and prior to four years, and can last between 45 minutes to two hours.
The child must be hospitalized for a period of three days with urethral catheter into the bladder (this can stay a maximum of seven days, but the child is already at home). The dressing is covered by two diapers and is changed every two days. After this phaseand up to one month after the operation, the precautions are, in general, that the child will not be traumatized.
Because there are many particulars, each situation must be evaluated individually. Generally, as a example, in the case of distal Hypospadias (default is on the glanular part of the penis) or medium (default is located in the distal third of the penis), it is only required surgery.
The Hypospadias is one of the most common defects of the male genital apparatus. In the case of women, congenital abnormal opening of the urethra gives to the inner part of the vagina but this is a situation much rarer than in the male sex.
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