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
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Effect of neoadjuvant chemotherapy on women undergoing breast cancer surgery and immediate breast reconstruction with latissimus dorsi flap and silicone implants(2017) D'ALESSANDRO, Gabriel Salum; POVEDANO, Alejandro; SANTOS, Lauren Klas Kurk Leme dos; MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; GOES, Joao Carlos de SampaioThe use of the latissimus dorsi flap in immediate breast reconstruction is a relatively simple procedure using a flap with a very reliable and consistent vascularity. Neoadjuvant chemotherapy improves local surgical conditions; however, most chemotherapeutic agents are cytotoxic and may increase the risk of postoperative complications. This study evaluated the effects of neoadjuvant chemotherapy on women with cancer who underwent immediate breast reconstruction with latissimus dorsi flap and silicone implants. Data were collected from medical records of 102 patients with cancer who had undergone immediate breast reconstruction with latissimus dorsi flap and silicone implants from August 2010 to December 2014. Thirty-three patients received neoadjuvant chemotherapy (study group) and 69 patients underwent primary surgical treatment (control group). Three (2.9%) patients in the study group had a major postoperative complication (two cases of hematoma requiring surgical drainage and a case of flap necrosis), which was the only variable showing a significant difference between groups (P = 0.032). Neoadjuvant chemotherapy followed by cancer surgery with immediate breast reconstruction with latissimus dorsi flap and silicone implants was not associated with an increased risk of postoperative surgical and clinical minor complications. It was associated with a significant increase in postoperative major complications, despite the small number of cases. However, patients who received neoadjuvant chemotherapy had a significantly more aggressive disease and advanced-stage cancer, and required a more extensive cancer surgery.
- 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.
- Usefulness of Radio Frequency Identification Device in Diagnosing Rotation of Motiva SmoothSilk Implants after Augmentation Mammoplasty(2019) MUNHOZ, Alexandre Mendonca; CHALA, Luciano; MELO, Giselle Guedes de; MARQUES FILHO, Ary de Azevedo; TUCUNDUVA, Tatiana; GEMPERLI, RolfBreast implant displacement has been described as a significant risk following augmentation mammoplasty. Magnetic resonance imaging (MRI) is considered the method of choice for diagnosing implant complications, but it has its limits in assessing correct implant position and displacement. Motiva SmoothSilk/SilkSurface (R) Implants (MSS) are the first to incorporate a radio frequency identification device (RFID), which produces an imaging artifact in MRI sequences. Given the frequency of breast augmentation procedures and the recent US Food and Drug Administration prospective trial involving SS with RFID, further analysis of implant stability and diagnostic imaging methods to evaluate implant positioning is necessary. The objective of this study was to assess the use of MRI with this new RFID-containing implant as a new tool to assess correct implant positioning. The authors performed this technique in 5 patients (10 implants) undergoing primary breast augmentation or revision surgery with MSS implants (255-385 cc, mean = 325 cc). The average area and volume of the artifact were 15.7 cm(2) and 31.75 cm(3), respectively. All cases presented satisfactory results, with 1 case of implant displacement. Our clinical and radiological outcome demonstrated that RFID technology is a useful tool for correct visualization of the implant position and diagnosis of complications such as slight displacements or rotation. To our knowledge, this is the first RFID breast implant that has been objectively evaluated for MRI issues.
- 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.
- 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.
- Outcome analysis and assessment of the lower pole expansion following breast augmentation with ergonomic implants: Optimizing results with patient selection based on 5-year data(2024) MUNHOZ, Alexandre Mendonca; NETO, Ary de Azevedo Marques; MAXIMILIANO, Joao; FRAGA, MurilloBackground: Silicone implants have gone through adaptations to improve esthetic outcomes. With the progress of technology, including gel rheology, different properties have been introduced. Ergonomic style implants (ESI) feature enhanced rheological properties and provide a shaped contour with a round base.Objectives: This study investigated outcomes for ESI in breast augmentation concerning lower pole stretching (LPS) and implant stability and describes an algorithm to assist in decision- making.Methods: A total of 148 patients (296 breasts) underwent breast augmentation with ESI; this procedure was indicated in patients with good skin quality and < 6 cm between the nip- ple-areola complex and the inframammary fold.Results: The mean patient age was 29.6 years (range: 19-39), and 93 patients (62.8%) under- went primary breast augmentation with demi/full projection (average volume of 245 cc [175-375 cc]). Axillary incision and subfascial pocket were indicated in 115 (77.7%) and 72 (48%) cases, respectively. Average LPS values were 32.2% (24.91 mm) and 10.86% (9.42 mm) at up to 10 days and 10 days to 12 months postprocedure, respectively. Patients were followed for a mean of 29.9 +/- 26.4 months (range: 6-66). Complication rates per breast and per patient were 5% and 10%, respectively, and included subcutaneous banding in the axilla (1.6%), implant displacement (1.2%), and wound dehiscence (0.8%). No cases of infection, seroma, or rippling complications were observed.Conclusions: The present decision-making algorithm summarizes the process involved in breast augmentation using ESI and is intended to help standardize decisions. With correct planning, long-lasting outcomes can be achieved due to favorable interactions between ESI and the patient's tissues.(c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
- Subfascial Axillary Hybrid Breast Augmentation: Technical Highlights and Step-by-Step Video Guide(2023) MUNHOZ, Alexandre Mendonca; NETO, Ary de Azevedo Marques; MAXIMILIANO, JoaoAdvances in breast augmentation techniques have led to safety improvements and better aesthetic results. The concurrent combination of the axillary approach with a subfascial pocket has been suggested for augmentation procedures, because it avoids breast scarring and the limitations of submuscular positioning represented by breast animation when the pectoral muscle is contracted. With the improvement of autogenous fat grafting techniques, new implant coverage options and more natural results have been proposed with more superficial implant pockets; simultaneous autogenous fat grafting with silicone implants (defined as hybrid breast augmentation) has recently been evaluated as a promising technique. Combining these two procedures allows core volume projection and natural cleavage while camouflaging implant edges. Fat grafting is also useful in reducing intermammary distance and achieving a smaller and smoother transition between the breasts. This article and the accompanying videos provide a detailed, step-by-step guide to hybrid breast augmentation using a subfascial axillary approach, with a predictable and optimized surgical outcome.
- Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction(2019) MONTAG, Eduardo; OKADA, Alberto; ARRUDA, Eduardo G. P.; MUNHOZ, Alexandre M.; BUSNARDO, Fabio F.; GEMPERLI, RolfBACKGROUND: Implant-based breast reconstruction (IBR) is the most common approach to reconstruct mastectomy deffects. Infection following breast reconstruction can be devastating and lead to loss of the reconstruction due to the need of implant removal. The serratus anterior muscle flap is widely used during breast reconstruction to provide coverage of the implant/expander. METHODS: We present the application of the serratus anterior muscle flap to treat implant exposure after breast reconstruction. CASES PRESENTATION: Two patients who experienced implant exposure after breast reconstruction were successfully treated with partial capsulectomy, pocket irrigation and implant coverage with a serratus anterior muscle flap. RESULTS: No post operative complications have been observed while implant retention was achieved in both cases. CONCLUSIONS: The serratus anterior muscle flap is an option to treat implant exposure following breast reconstruction in selected cases. This flap could be used to prevent implant exposure in critical cases. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
- Subdermal neo-umbilicoplasty in abdominoplasty(2018) POVEDANO, Alejandro; SANTOS, Gabriel Salum D'Alessandro Lauren Klas Iurk Leme dos; MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; GOES, Joao Carlos SampaioBackground Umbilicoplasty is an important surgical procedure in abdominoplasty, regardless of the technique used. An unaesthetic umbilicus often irreversibly affects surgical outcomes. This study describes the experience of our team with the subdermal neo-umbilicoplasty technique and assesses patient satisfaction with the appearance of the new umbilicus. Methods Fifty-eight patients with abdominal deformity underwent abdominoplasty with subdermal neo-umbilicoplasty. Patients were followed up for at least 1 year with photographic documentation, assessment of patient satisfaction, and evaluation of eventual postoperative complications. Results Postoperative complications included one case of shallow umbilicus, four cases of superficial necrosis, and one case of midline deviation. No patient required surgical revision. There was a high level of patient satisfaction with the natural-looking umbilicus. Conclusions Subdermal neo-umbilicoplasty resulted in low postoperative complications and provided a new, natural-looking umbilicus without external scars.
- 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.