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
42 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 42
- Hybrid Augmentation Mastopexy with New Generation of Smooth Surface Implants: Combining the Benefits of Fat Grafting, Inferior Muscle Support, and an L-Shaped Scar(2023) MUNHOZ, Alexandre Mendonca; NETO, Ary de Azevedo Marques; MAXIMILIANO, JoaoBackground:Augmentation mastopexy (AM) is a challenging procedure. Complications include implant displacement and visibility, which can be addressed, but the stability of the smooth implant surface and poor soft-tissue coverage may present limitations. This article describes a surgical technique for AM using a composite reverse inferior muscle sling associated with autogenous fat grafting. Methods:Forty-five patients (90 breasts; mean age, 37.7 & PLUSMN; 7.2 years) underwent hybrid composite reverse inferior muscular sling AM. An upper/medial pole area between the implant and the clavicle region and parasternal area was marked to receive fat grafting and divided into three zones. Three-dimensional imaging was used to evaluate lower pole stretch and intermammary distance. Results:The average implant volume was 265 cc (range, 175 to 335 cc). The average fat volumes in zones I/II and III were 80.1 (range, 61.6 to 95.2 cc) and 39.3 (range, 25.2 to 47.3 cc), respectively. Five complications were observed in three patients (6.6%)-minor dehiscence in two (4.4%) and nipple-areola asymmetry in one (2.2%). The lower pole stretched 11.51% (9.9 mm) and 9.8% (8.5 mm) on the right and left sides, respectively (P < 0.0001), between 10 days and 1 year postoperatively. The intermammary distance was reduced, on average, 49.9% (25.1 mm) (P < 0.001) between the preoperative value and 1 year postoperatively. Conclusions:Hybrid composite reverse inferior muscular sling has led to improved aesthetic results for patients with breast ptosis and poor tissue coverage. Fat grafting and recognizing cleavage zones are still important to obtain satisfactory results. This procedure offers a good alternative for AM candidates, providing an adequate smooth surface for implant stabilization.
- 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
- Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques(2011) MUNHOZ, Alexandre Mendonca; ALDRIGHI, Claudia Maria; MONTAG, Eduardo; ARRUDA, Eduardo; BRASIL, Jose Augusto; FILASSI, Jose Roberto; ALDRIGHI, Jose Mendes; GEMPERLI, Rolf; FERREIRA, Marcus CastroBackground: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
- 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.
- The influence of type of vascular pedicle occlusion on the viability of skin island flaps. A postoperative quantitative assessment of flap survival in an experimental model in rats(2013) GEMPERLI, Rolf; MUNHOZ, Alexandre MendoncaPURPOSE: To evaluate the role of pedicle occlusion on the viable area of a skin island flap. METHODS: An epigastric skin island flap was performed in 160 Wistar rats. The animals were randomly divided into four groups: G-1: occlusion of inferior epigastric artery; G-2: inferior epigastric vein; G-3: inferior epigastric vessels (artery/vein). At varying times postoperatively (2,3,4,5th day), animals from each group were randomly selected, and the pedicle was occluded. On the 10th. postop. day, the skin flaps were evaluated by templates to determine the percentage of surviving skin. The computer HP T 9830A captured the photographs and the mean flap necrosis area was assessed. RESULTS: An increasing area of flap survived with less area of necrosis with increased time of days intervals. In the G-1, the mean area of necrosis observed (two to five days) were 95.2, 60.8, 31 and 3.7 % respectively. In the G-2 were 95.5, 57.6, 19.5 and 5.6 % respectively. In the G-3, a 100, 80, 32.4 and 14.9 % of mean area was observed. CONCLUSIONS: The arterial suppy/venous drainage is important for flap circulation up to five days following pedicle occlusion. After this period, the pedicle can be interrupted once the circulation through the flap margins has already been established.
- Qualitative analysis of the viability of autogenous fat grafts grafted in different environments of interstitial pressure. Preliminary results and description of a new experimental model in mini-pigs(2017) ARRUDA, Eduardo Gustavo Pires de; MUNHOZ, Alexandre Mendonca; MATSUMOTO, Walter; UEDA, Thiago; COUDRY, Renata de Almeida; GEMPERLI, RolfPurpose: To evaluate the feasibility of an experimental model of autologous fat graft (AFG) in different interstitial pressure (IP) environments. Methods: Three mini-pigs(Minipig-BR) with age of 8 months (weight: 25-30 kg) were used. AFG were collected from the bucal fat pad, and grafted in the intramuscular pocket (biceps femoralis muscle). IP model was based on a fusiform ressection followed by primary closure ""under tension"". A blood pressure catheter located in the intramuscular region connected to a pressure module was applied to quantify IP. Results: The mean operative time was 236 min (210 -272 min). All the AFG and muscular segments were removed successfully. Average interstitial pressure CP and H were 3 and 10.6 mmHg respectively. The AFG were biopsied for histopathological analysis 30 days after graft. Hematoxylin-eosin staining and immunohistochemical analyzes (TNF-alpha, CD31 and Perilipine with monoclonal antibodies) were employed. Conclusion: The data show that minipigs model could be used as a recipient site for autologous fat graft techniques and allow the development of studies to explore the AFG intake and pathophysiology response.
- Fat Grafting and the Palpable Breast Mass in Implant-Based Breast Reconstruction: Incidence and Implications(2020) MUNHOZ, Alexandre Mendonca
- Transaxillary Subfascial Augmentation Mammaplasty with Anatomic Form-Stable Silicone Implants(2015) MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; GOES, Joao Carlos SampaioThis article presents an overview of the transaxillary subfascial approach to primary breast augmentation with the latest-generation anatomic form-stable silicone implants. Although the axillary approach is a well-described technique for breast augmentation, there have been few reports concerning the subfascial pocket, especially in association with anatomic form-stable texturized silicone gel implants. The authors present their experience with the present technique, along with technical details concerning the placement of the superior pole of the anatomic implant underneath the superficial fascia of the pectoralis major.
- Occult Carcinoma in 866 Reduction Mammaplasties: Preserving the Choice of Lumpectomy(2011) MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; FILASSI, Jose Roberto
- 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