Physical activity in women undergoing mastectomy and breast reconstruction

BACKGROUND: Regular physical activity has been recommended for the prevention and treatment of coronary heart disease, diabetes mellitus, and hypertension. Besides being a protective factor against breast cancer, physical activity following the diagnosis of breast cancer has been associated with an improved quality of life and survival. The aim of this study was to assess levels of physical activity in women who had undergone mastectomy without breast reconstruction and in women who had undergone breast reconstruction after breast cancer treatment. METHODS: Two groups, each with 18 patients, comprised the patient series. One group comprised women who had undergone mastectomy without breast reconstruction, and the other group comprised women who had undergone mastectomy and breast reconstruction. All patients were aged between 18 and 60 years. The exclusion criteria were physical disability; illiteracy; ongoing chemotherapy, radiation therapy, or psychiatric therapy; and surgery performed within the previous 12 months. Study participants completed the International Physical Activity Questionnaire. Statistical analysis was performed by applying the chi-square and Student's t tests, adopting a significance level of P < 0.05. RESULTS: In the group of women who had undergone mastectomy without breast reconstruction, 16.7% were very active, 61.1% were active, and 22.2% were insufficiently active. In the group of women who had undergone mastectomy with breast reconstruction, 55.6% were very active, 33.3% were active, and 11.1% were insufficiently active. The difference between the groups was statistically significant (P < 0.0001). CONCLUSIONS: In this study, the level of physical activity among women who underwent breast reconstruction was higher than that among women who underwent mastectomy without breast reconstruction.INTRODUÇÃO: A prática regular de atividade física tem sido recomendada para prevenção e tratamento de doenças coronárias, diabetes melito e hipertensão arterial. Além de fator protetor, a atividade física após o diagnóstico de câncer de mama tem sido correlacionada a aumento da qualidade de vida e da sobrevida. O objetivo deste estudo é avaliar o nível de atividade física de mulheres mastectomizadas sem reconstrução mamária e de mulheres submetidas a reconstrução mamária pós-tratamento de câncer de mama. MÉTODO: A casuística foi composta por 2 grupos, um de mulheres mastectomizadas sem reconstrução mamária e outro de mulheres mastectomizadas e submetidas a reconstrução mamária pós-mastectomia, ambos com 18 pacientes. Todas as pacientes tinham idade entre 18 anos e 60 anos. Os critérios de exclusão foram: deficiência física, analfabetismo, vigência de tratamento de quimioterapia, radioterapia ou psiquiátrico, e tratamento cirúrgico realizado em período inferior a um ano. As voluntárias responderam ao Questionário Internacional de Atividade Física (IPAQ). A análise estatística foi realizada aplicando-se o teste qui-quadrado e o teste t de Student, tendo sido adotado o nível de significância de P < 0,05. RESULTADOS: No grupo de mulheres mastectomizadas sem reconstrução mamária, 16,7% eram muito ativas, 61,1% ativas e 22,2% insuficientemente ativas. No grupo de mulheres com a mama reconstruída, essas incidências foram de 55,6%, 33,3% e 11,1%, respectivamente. Houve diferença estatisticamente significante entre os grupos (P < 0,0001). CONCLUSÕES: O nível de atividade física entre as mulheres submetidas a reconstrução mamária é melhor que entre as mulheres mastectomizadas sem reconstrução mamária.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaSociedade Brasileira de Cirurgia PlásticaUNIFESP, EPMSciEL

Sexuality, depression and body image after breast reconstruction

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group

Brazilian version of the Breast Evaluation Questionnaire: cultural adaptation and validation

BACKGROUND: Measurable data on plastic surgery outcomes are scarce. In recent years, questionnaires to measure quality of life have been used globally. In Brazil, there are no questionnaires validated and adapted in the Brazilian population that specifically assess quality of life after breast surgery. The aim of this study was to translate the Breast Evaluation Questionnaire (BEQ 55) into Portuguese, and culturally adapt and validate the translation for use in Brazil. METHODS: Two translations, two revisions by a multidisciplinary group, and two back translations of the questionnaire were performed. Cultural adaptation was performed by applying the questionnaire to groups of 20 patients from the plastic surgery outpatient clinic. The questionnaire included relevant modifications for better understanding of the questions. To test the questionnaire's reproducibility and validity, 20 patients were interviewed on two separate occasions. On the first occasion, they were interviewed by different interviewers, and on the second occasion (after 7 days and after 14 days), by only one. In addition, the Short-Form 36 was applied during the first interview. RESULTS: During cultural adaptation, questions were modified to facilitate the patients' understanding. A new group was tested to confirm that items were understood. Internal consistency of the questionnaire ranged between 0.931 and 0.936. The interobserver reproducibility coefficient was 0.962, and the intraobserver reproducibility coefficient was 0.919. Only the domains of the SF-36 regarding functional capacity, general health status, and emotional aspects correlated with the total score of the BEQ 55. CONCLUSIONS: The BEQ 55 questionnaire was successfully translated and adapted. The Brazilian version was called Questionário de Avaliação das Mamas (BEQ-Brasil) and was demonstrated to be valid and reproducible.INTRODUÇÃO: Dados mensuráveis de resultados em cirurgia plástica são escassos. Nos últimos anos, instrumentos de medida de qualidade de vida vêm sendo utilizados em escala mundial. Não há instrumentos válidos e adaptados no Brasil para avaliar qualidade de vida especificamente para cirurgia das mamas. O objetivo deste estudo é traduzir para o português, adaptar culturalmente e validar o Breast Evaluation Questionnaire (BEQ 55) para uso no País. MÉTODO: Foram realizadas duas traduções e duas traduções reversas do instrumento, intercaladas por revisões de comitê multidisciplinar. A adaptação cultural foi feita com aplicação do questionário a grupos de 20 pacientes do ambulatório de cirurgia plástica, com modificações pertinentes para melhora do entendimento. Para testar a reprodutibilidade e a validade de construção, 20 pacientes foram entrevistados em duas ocasiões: na primeira, por entrevistadores diferentes, e na segunda (após 7 dias a 14 dias), por apenas um deles. Na primeira, foi aplicado também o Short-Form 36. RESULTADOS: Na adaptação cultural, foram modificadas todas as questões para facilitar o entendimento. Um novo grupo obteve boa compreensão de todas as questões. A consistência interna do instrumento variou de 0,931 a 0,936. O coeficiente de reprodutibilidade interobservador foi de 0,962 e o intraobservador, de 0,919. Apenas os domínios do SF-36 capacidade funcional, estado geral de saúde e aspectos emocionais tiveram correlação com o escore total do BEQ 55. CONCLUSÕES: O questionário foi traduzido e adaptado com sucesso, sendo a versão brasileira denominada Questionário de Avaliação das Mamas (BEQ-Brasil), e provou ser válido e reprodutível.Universidade Federal de São Paulo (UNIFESP)UNIFESP-EPM Programa de Pós-Graduação em Cirurgia TranslacionalUNIFESP-EPMUNIFESP-EPM Disciplina de Cirurgia PlásticaUNIFESP, EPM Programa de Pós-Graduação em Cirurgia TranslacionalUNIFESP-EPMUNIFESP, EPM Disciplina de Cirurgia PlásticaSciEL

Outcomes analysis of breast reduction in Brazilian women using the BREAST-Qs questionnaire: a crosssectional controlled study

OBJECTIVE: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women. METHODS: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Qs was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively. RESULTS: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales). CONCLUSION: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy

Image analysis software versus direct anthropometry for breast measurements

PURPOSE:To compare breast measurements performed using the software packages ImageTool(r), AutoCAD(r) and Adobe Photoshop(r) with direct anthropometric measurements.METHODS:Points were marked on the breasts and arms of 40 volunteer women aged between 18 and 60 years. When connecting the points, seven linear segments and one angular measurement on each half of the body, and one medial segment common to both body halves were defined. The volunteers were photographed in a standardized manner. Photogrammetric measurements were performed by three independent observers using the three software packages and compared to direct anthropometric measurements made with calipers and a protractor.RESULTS:Measurements obtained with AutoCAD(r) were the most reproducible and those made with ImageTool(r) were the most similar to direct anthropometry, while measurements with Adobe Photoshop(r) showed the largest differences. Except for angular measurements, significant differences were found between measurements of line segments made using the three software packages and those obtained by direct anthropometry.CONCLUSION:AutoCAD(r) provided the highest precision and intermediate accuracy; ImageTool(r) had the highest accuracy and lowest precision; and Adobe Photoshop(r) showed intermediate precision and the worst accuracy among the three software packages.Federal University of São PauloUniversidade Federal de São Paulo (UNIFESP) Department of SurgeryUNIFESPUNIFESP, Department of SurgeryUNIFESPSciEL

Depression and conservative surgery for breast cancer

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy-five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the &#967;2 test. RESULTS: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (&#967;2=9.97; p = 0.126). CONCLUSÍON: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed

Short Mood and Feelings Questionnaire for screening children and adolescents for plastic surgery: cross-cultural validation study

CONTEXT AND OBJECTIVE: Patient-reported outcome measurements assessing the emotional state of children and adolescents who seek plastic surgery are important for determining whether the intervention is indicated or not. The aim of this study was to cross-culturally adapt and validate the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) for Brazilian Portuguese, test its psychometric properties and assess the emotional state of children and adolescents who seek plastic surgery. DESIGN AND SETTING: Cross-cultural validation study conducted in a plastic surgery outpatient clinic at a public university hospital. METHODS: A total of 124 consecutive patients of both sexes were selected between September 2013 and February 2014. Forty-seven patients participated in the cultural adaptation of the questionnaire. The final version was tested for reliability on 20 patients. Construct validity was tested on 57 patients by correlating the Short Mood and Feelings Questionnaire (child/adolescent and parent versions) with the Strengths and Difficulties Questionnaire and the Rosenberg Self-Esteem scale. RESULTS: The child/adolescent and parent versions of the Short Mood and Feelings Questionnaire showed Cronbach's alpha of 0.768 and 0.874, respectively, and had good inter-rater reliability (intraclass correlation coefficient, ICC = 0.757 and ICC = 0.853, respectively) and intra-rater reliability (ICC = 0.738 and ICC = 0.796, respectively). CONCLUSIONS: The Brazilian-Portuguese version of the Short Mood and Feelings Questionnaire is a reproducible instrument with face, content and construct validity. The mood state and feelings among children and adolescents seeking cosmetic surgery were healthy.Univ Fed Sao Paulo UNIFESP, Dept Surg, Div Plast Surg, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Postgrad Program Translat Surg, Sao Paulo, SP, BrazilInst Fed Educ Ciencia & Tecnol Sul Minas IFSuldeM, Pouso Alegre, MG, BrazilUniv Vale do Sapucai UNIVAS, Coll Hlth Sci, Pouso Alegre, SP, BrazilUniv Fed Sao Paulo UNIFESP, Dept Surg, Div Plast Surg, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Postgrad Program Translat Surg, Sao Paulo, SP, BrazilWeb of Scienc

Back pain: an assessment in breast hypertrophy patients

OBJECTIVE: To evaluate the influence of breast hypertrophy on the incidence of back pain and how much they can interfere in patients' daily activities. METHODS: This was a cross-sectional analytic study in patients examined at the Outpatient Orthopedics and Plastic Surgery Departments at Samuel Libânio University Hospital in Pouso Alegre, MG. 100 women were examined, 50 presenting breast hypertrophy (study group) and 50 with normal breast size (control group). Breasts were classified according to Sacchini's criteria. The Numerical Rating Scale (NRS) and the Roland-Morris questionnaire were used in order to evaluate the magnitude of back pain and the limitations arising from these symptoms. RESULTS: The mean age of the patients in the study group was 32.2 years and 32.7 for the control group. The scores in the NRS scale and Roland- Morris Questionnaire were higher in the study group when compared to the control group. CONCLUSION: The results achieved showed that back pain is more severe and determined more extensive limitations in the daily activities for patients presenting breast hypertrophy.OBJETIVO: Avaliar a influência da hipertrofia mamária sobre as dores na coluna e o quanto poderão comprometer as atividades habituais das pacientes. MÉTODOS: Realizou-se estudo transversal analítico em pacientes dos ambulatórios de Ortopedia e Cirurgia Plástica do Hospital Universitário Samuel Libânio, Pouso Alegre - MG. Foram examinadas 100 mulheres, 50 com hipertrofia mamária (grupo estudo) e 50 com mamas normais (grupo controle). O tamanho das mamas foi classificado conforme critérios de Sacchini.. A Escala Numeral Analógica (NRS) e o questionário de Roland-Morris foram utilizados para avaliar a intensidade das dores na coluna e as limitações resultantes destes sintomas. Realizado teste estatístico comparando os grupos em relação as variáveis analisadas. RESULTADOS: A média da idade das pacientes do grupo estudo e controle foram de 32,2 anos e de 32,7 anos respectivamente, e o IMC foi maior no grupo estudo. Os escores do NRS e do Roland-Morris foram maiores no grupo de estudo em relação ao grupo controle com significância estatística. CONCLUSÃO: Os resultados obtidos mostraram que as dores nas costas são mais intensas e determinaram maior limitação das atividades habituais em pacientes portadoras de hipertrofia mamária.Universidade do Vale do Sapucaí Hospital das Clínicas Samuel Libânio Departamento de Ortopedia TraumatologiaUNIFESPUniversidade do Vale do Sapucaí Hospital Clínicas Samuel Libânio Divisão de Cirurgia PlásticaUNIVÁS Departamento de BioestatísticaUNIFESPSciEL

Mastectomia versus tratamento cirúrgico conservador: impacto na qualidade de vida de mulheres com câncer mamário

OBJECTIVES: to compare the impact of mastectomy and conservative surgery on the quality of life of patients with breast cancer. METHODS: an assessment was made of the quality of life of patients undergoing mastectomy or segmentary mastectomy, at the Pouso Alegre Clinical Hospital, in the Brazilian State of Minas Gerais, using SF-36. The patients were grouped by age (50 years) and years of schooling (8 years). The Mann-Whitney test was used to compare the groups with regard to the age and schooling domains of SF-36. RESULTS: a significant difference between the two groups was found in the domains of physical functioning (p=0.04) and pain (p=0.01): with the patients undergoing a mastectomy registering the worst scores. Young patients who had undergone a mastectomy displayed the worst quality of life in terms of physical functioning (p=0.03), pain (p=0.01) and social functioning (p=0.01); those undergoing conservative surgery aged over 50 years scored worst on role emotional (p=0.05). Patients undergoing a mastectomy with lower levels of schooling scored lower in physical functioning (p=0.01), role physical (p=0.05) and pain (p=0.05). Among those who had attended school for more than eight years, those having undergone a mastectomy scored less in the pain domain (p=0.04). CONCLUSIONS: patients who had undergone a mastectomy had worse results in the physical component of the evaluation of quality of life and this negative impact was more strongly felt among younger patients and those with lower levels of schooling.OBJETIVOS: comparar o impacto da mastectomia e da cirurgia conservadora na qualidade de vida de pacientes com câncer mamário. MÉTODOS: avaliou-se qualidade de vida de pacientes submetidas à mastectomia ou à mastectomia segmentar, no Hospital das Clínicas de Pouso Alegre, Minas Gerais, Brasil, utilizando-se o SF-36. As pacientes foram estratificadas quanto à idade (50 anos) e escolaridade (8 anos). Aplicou-se o teste de Mann-Whitney para comparar os grupos quanto aos domínios do SF-36, idade e escolaridade. RESULTADOS: observou-se diferença significante entre os grupos nos domínios capacidade funcional (p=0,04) e dor (p=0,01): as pacientes mastectomizadas com piores resultados. Pacientes mastectomizadas mais jovens apresentaram pior qualidade de vida em capacidade funcional (p=0,03), dor (p=0,01) e aspectos sociais (p=0,01); as submetidas à cirurgia conservadora, com mais de 50 anos, resultado pior em aspectos emocionais (p=0,05). Pacientes mastectomizadas com menor escolaridade apresentaram escores menores em capacidade funcional (p=0,01), aspectos físicos (p=0,05) e dor (p=0,05). Entre as que frequentaram a escola por mais de oito anos, as mastectomizadas pontuaram menos no domínio dor (p=0,04). CONCLUSÕES: pacientes mastectomizadas apresentaram piores resultados no componente físico da qualidade de vida, e este impacto negativo foi mais acentuado entre pacientes mais jovens e com menor escolaridade.Universidade do Vale do SapucaíUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL