ALEXANDRE MENDONCA MUNHOZ
Índice h a partir de 2011
15
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
8 resultados
Resultados de Busca
Agora exibindo 1 - 8 de 8
- Response to: Nano-Surface Implants: Indications and Limitations(2021) SFORZA, Marcos; BOTTI, Giovanni; HEDEN, Per; ZACHEDDU, Renato; MUNHOZ, Alexandre Mendonca; MAYO, Federico; KINNEY, Brian M.; HAMMOND, Dennis C.; CORDUFF, Niamh; MORELLI, Humberto Uribe; STAVROU, Demetris; CENTENO, Jesus
- Delphi Study Consensus Recommendations: Patient Selection and Preoperative Planning Measurements for Natrelle 410(2015) HEDEN, Per; BROWN, Mitchell H.; LUAN, Jie; MAXWELL, G. Patrick; MUNHOZ, Alexandre Mendonca; CARTER, MollieBackground: There is considerable variation in the planning and implementation process for breast augmentation. Although general guidelines are available, the distinctive characteristics of the Natrelle 410 breast implant warrant surgical guidelines specific to this device. This study aimed to develop consensus recommendations for patient selection and preoperative planning for Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in this study, which used a modified Delphi method. Participants completed 2 rounds of online surveys, with the second round (Recommendations Survey) based on responses from the first round. Respondents also listed their top priorities for using Natrelle 410 implants. Results: Participants (n = 22) reached consensus on 15 of 18 criteria for patient selection; tuberous breasts, patient preference regarding upper pole shape, and asymmetry of the breasts were the top 3 patient characteristics considered appropriate for the use of Natrelle 410. Consensus was reached on 38 of 51 items related to preoperative planning, with 8 measurements and 6 markings recommended by the participants. Patient-desired outcome was considered the most essential element for Natrelle 410 implant selection; quality of skin envelope and height and width dimension of the breast were selected as the most essential elements for Natrelle 410 implant volume selection. Conclusions: The modified Delphi method resulted in consensus recommendations for patient selection and preoperative planning in primary breast augmentation with the Natrelle 410 breast implant. These recommendations and priorities, used in concert with a surgeon's clinical experience, are designed to optimize surgical outcomes.
- The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans(2021) DOLOFF, Joshua C.; VEISEH, Omid; MEZERVILLE, Roberto de; SFORZA, Marcos; PERRY, Tracy Ann; HAUPT, Jennifer; JAMIEL, Morgan; CHAMBERS, Courtney; NASH, Amanda; AGHLARA-FOTOVAT, Samira; STELZEL, Jessica L.; BAUER, Stuart J.; NESHAT, Sarah Y.; HANCOCK, John; ROMERO, Natalia Araujo; HIDALGO, Yessica Elizondo; LEIVA, Isaac Mora; MUNHOZ, Alexandre Mendonca; BAYAT, Ardeshir; KINNEY, Brian M.; HODGES, H. Courtney; MIRANDA, Roberto N.; CLEMENS, Mark W.; LANGER, RobertSilicone is widely used in chronic implants and is generally perceived to be safe. However, textured breast implants have been associated with immune-related complications, including malignancies. Here, by examining for up to one year the foreign body response and capsular fibrosis triggered by miniaturized or full-scale clinically approved breast implants with different surface topography (average roughness, 0-90 mu m) placed in the mammary fat pads of mice or rabbits, respectively, we show that surface topography mediates immune responses to the implants. We also show that the surface surrounding human breast implants collected during revision surgeries also differentially alters the individual's immune responses to the implant. Moreover, miniaturized implants with an average roughness of 4 mu m can largely suppress the foreign body response and fibrosis (but not in T-cell-deficient mice), and that tissue surrounding these implants displayed higher levels of immunosuppressive FOXP3(+) regulatory T cells. Our findings suggest that, amongst the topographies investigated, implants with an average roughness of 4 mu m provoke the least amount of inflammation and foreign body response. The surface topography of breast implants mediates the immune responses to them, and implants with an average roughness of 4 mu m largely suppress foreign body response and fibrosis.
- Breast Implant Surfaces and Their Impact on Current Practices: Where We Are Now and Where Are We Going?(2019) MUNHOZ, Alexandre Mendonca; CLEMENS, Mark W.; NAHABEDIAN, Maurice Y.Most commercially available breast implants feature some degree of elastomer surface modifications to increase surface roughness, in part because several clinical series have demonstrated positive outcomes from texturizing. However, the literature shows that textured implants support higher rates of bacterial growth, and there is a clear association between increased bacterial contamination and host response in vivo, such as capsular contracture. Furthermore, the infectious theory related to bacterial contamination has recently been described as a potential cause in the etiology of anaplastic large-cell lymphoma. Recent research has focused on the physiology of breast implant surfaces advances and how they interact with the body, creating new surface technologies which have the potential to affect all aspects of breast surgery. Understanding how surface properties affect inflammatory cell response will be essential in designing implants that can provide an esthetic solution while also minimizing long-term clinical complications. This special topic highlights the current knowledge on silicone implant surfaces, as well as innovations that have shaped and will continue to change the silicone breast implant industry in the future. It also provides an overview of the principal surfaces that exist and may find clinical applications in esthetic and reconstructive breast surgery. As additional advances emerge, objective tools will be required to evaluate the different surfaces available on the market, along with the long-term efficacy of new technologies.
- Response to ""Clarification About 'Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant'""(2019) SFORZA, Marcos; HAMMOND, Dennis C.; BOTTI, Giovanni; HEDEN, Per; QUIROS, Manuel Chacon; MUNHOZ, Alexandre Mendonca; KINNEY, Brian M.; CORDUFF, Niamh
- Delphi Consensus Recommendations: Intraoperative Technique and Postoperative Management of Patients with Natrelle 410 Implants(2015) MAXWELL, G. Patrick; BROWN, Mitchell H.; HEDEN, Per; LUAN, Jie; MUNHOZ, Alexandre Mendonca; CARTER, MollieBackground: Anatomically shaped, form-stable Natrelle 410 breast implants were approved in Europe in 1993 and in the United States in 2013. Although general guidelines for breast augmentation are available, the distinctive characteristics of Natrelle 410 warrant specific guidelines for this device. The goal of this study was to generate consensus recommendations for intraoperative technique and postoperative management with Natrelle 410 in primary breast augmentation. Methods: Surgeons were invited to participate in the study, which used a modified Delphi method. Participants completed 2 rounds of online surveys; the second survey (Recommendations Survey) was generated based on first survey results. Respondents also listed top priorities for use of Natrelle 410. Results: Participants (n = 22) reached consensus on 15 of 18 perioperative and surgical techniques; dual-plane placement, tight pockets, and limiting the boundaries of dissection were among intraoperative techniques considered most important for Natrelle 410. Consensus was reached for 18 of 32 items regarding postoperative management and 6 of 9 open-ended postoperative activity restrictions. Consensus on activity restrictions with specified time limits were similar to consensus recommendations on general restrictions. Top participant-identified intraoperative and postoperative management practices for Natrelle 410 were dual-plane placement of the implant and wearing a bra postoperatively, respectively. Conclusions: The Delphi method identified consensus recommendations on a broad range of intraoperative techniques and postoperative management practices for primary breast augmentation with Natrelle 410. These recommendations and priorities provide surgeons with a framework that, together with the surgeon's experience, will contribute to optimal clinical outcomes with Natrelle 410.
- Breast Tissue Expander With Radiofrequency Identification Port: Assessment of MRI Issues(2020) BAYASGALAN, Mungunchimeg; MUNHOZ, Alexandre Mendonca; SHELLOCK, Frank G.OBJECTIVE. Breast tissue expanders with magnetic ports are MRI unsafe, preventing patients from benefiting from the diagnostic capabilities of MRI. A tissue expander was recently developed with a radiofrequency identification (RFID) port used for needle location and expansion that may be acceptable for a patient undergoing MRI. The purpose of this investigation was to evaluate MRI issues using standardized techniques and well-accepted methods for this tissue expander with RFID port. MATERIALS AND METHODS. The breast tissue expander with RFID port (Motiva Flora Tissue Expander, Establishment Labs) was assessed for magnetic field interactions (translational attraction and torque, 3 T), MRI-related heating (1.5 T/64 MHz and 3 T/128 MHz), artifacts (3 T), and functional changes associated with different MRI conditions (1.5/64 MHz and 3 T/128 MHz). RESULTS. Magnetic field interactions were minor (deflection angle of 2 degrees and no torque) and thus will not pose a risk. At 1.5 T/64 MHz and 3 T/128 MHz, the highest temperature elevations (1.7 degrees C and 1.9 degrees C, respectively) were physiologically inconsequential. The tissue expander with RFID port exhibited relatively small artifacts on MRI. Exposures of the tissue expander with RFID port to different MRI conditions did not impact the ability to localize the RFID port or to read the electronic serial number. CONCLUSION. The findings indicated that this tissue expander with RFID port is ""MR Conditional"" for a patient referred for MRI at 1.5 T or 3 T. Importantly, the relatively small artifact associated with this implant offers potential advantages for patients undergoing MRI compared with tissue expanders that have magnetic ports that create substantial signal losses and distortions on MR images.
- Expert Consensus on the Use of a New Bioengineered, Cell-Friendly, Smooth Surface Breast Implant(2019) SFORZA, Marcos; HAMMOND, Dennis C.; BOTTI, Giovanni; HEDEN, Per; QUIROS, Manuel Chacon; MUNHOZ, Alexandre Mendonca; KINNEY, Brian M.; CORDUFF, NiamhBackground Although general guidelines are available for established silicone gel breast implants, the unique characteristics of the latest Motiva implants warrant specific guidelines. Objectives This study aimed to generate consensus recommendations and summarize expert-based advice to better understand current surgical practices and to establish guidelines for surgeons transitioning from other implant devices to the Motiva implants. Methods A survey was compiled by 12 plastic surgeon experts in aesthetic and reconstructive breast surgery and 1 biotechnology scientist, and distributed to 36 plastic surgeons to establish a consensus on the use of these devices. Surgical techniques, complication rates, and implant selection were among the topics discussed. Results The experts agreed on 3 core principles regarding the use of Motiva Round and Ergonomix implants. Firstly, the dissected pocket needs to be close fitting and steps must be taken to prevent expansion of the pocket. Secondly, implant selection must be individualized. Finally, surgical planning and technique must be carefully considered. When questioned about problems they had ecountered, 84.6% of the experts agreed that they experienced fewer overall complications and 76.9% confirmed reduced capsular contracture rates with these devices. Overall, 84.6% of the experts favored selecting Motiva Ergonomix implants over Round implants to achieve a more natural look. In addition, 92.3% of the experts agreed that Motiva implants, due to their innovative technology, reduce the risk of anaplastic large-cell lymphoma. Conclusions This international consensus of leading practitioners will assist plastic surgeons with patient selection, preoperative planning, and surgical technique. These recommendations are designed to optimize surgical outcomes, resulting in lower overall complication rates, more natural-looking breasts, and highly satisfied patients.