Miguel Sabino Neto

Background: Breast symmetry and harmony remain challenging goals in aesthetic breast surgery. Preoperative marking is fundamental for planning; however, most techniques rely on nipple–areola complex (NAC) distances and subjective visual assessment, often neglecting thoracic width, height, and the true breast footprint. A geometric framework based on harmonic proportions can help standardize preoperative planning and may improve the reproducibility of breast markings. Methods: A two-dimensional geometric template was developed by integrating constant anatomical references (sternum, clavicles, axillary and acromial lines, and umbilicus) with proportional relationships derived from aesthetic and anthropometric studies. The template was calibrated for each patient’s using thoracic width and height and was designed to be superimposed on standardized frontal photographs. It guides the NAC position, breast width, upper pole contour, and inframammary fold level. The model was applied in mastopexy and reduction mammaplasty as a preoperative planning and postoperative photographic overlay comparison, as well as a visual aid in resident teaching sessions. Results: The template was easily incorporated into daily practice using standard clinical photographs and simple digital overlays. Geometric gridlines and proportional curves allowed visualization of the NAC position, breast symmetry, and contour in relation to thoracic dimensions. Repeated overlays facilitated the longitudinal comparison of breast position and shape. During teaching sessions, the template was used as a visual aid to facilitate resident understanding of the geometric relationships between thoracic anatomy, the breast footprint, and marking decisions. Conclusions: This innovative geometric template offers a simple, visually intuitive tool for standardizing preoperative marking and supporting postoperative photographic overlay comparisons in breast surgeries. It is inexpensive, compatible with existing photographic workflows, and may support training and future digital or artificial intelligence integration. Prospective studies are needed to quantify the impact of these factors on aesthetic outcomes and learning curves. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Resumo: Diretrizes rápidas são necessárias em cenários que exigem recomendações oportunas, como o surgimento de novas intervenções ou demandas urgentes de orientação clínica, algo frequente na cirurgia plástica. Entretanto, a redução do tempo de desenvolvimento não deve comprometer o rigor metodológico nem a transparência do processo. Este estudo teve como objetivo sintetizar recomendações metodológicas para a elaboração de diretrizes rápidas. Foi realizada uma revisão narrativa da literatura baseada em publicações metodológicas sobre desenvolvimento de diretrizes rápidas. A síntese dos dados foi conduzida de forma qualitativa e narrativa, organizando os achados de acordo com as diferentes etapas do processo de elaboração de diretrizes, desde o planejamento e definição do escopo até a formulação, implementação e atualização das recomendações. A análise dos estudos identificou recomendações metodológicas para todas as etapas do desenvolvimento de diretrizes rápidas, incluindo definição do escopo, priorização de perguntas estruturadas, composição do painel, avaliação e síntese das evidências, formulação das recomendações e planejamento da implementação e atualização. Estratégias para otimizar o processo incluíram o uso de diretrizes previamente publicadas, aplicação do modelo de ADOLOPMENT, priorização de revisões sistemáticas existentes e utilização de frameworks estruturados, como GRADE, Summary of Findings (SoF) e Evidence to Decision (EtD). Entre os principais desafios, destacaram-se limitações de tempo, recursos humanos, disponibilidade de evidências e financiamento. Diretrizes rápidas podem ser desenvolvidas com qualidade metodológica adequada, desde que sejam utilizados processos estruturados, transparentes e baseados em evidências. A síntese apresentada pode servir como guia prático para a elaboração de diretrizes rápidas, especialmente no âmbito da Sociedade Brasileira de Cirurgia Plástica (SBCP).

Background Breast asymmetry occurs when there is a discrepancy in the shape, volume, or positioning of the breasts. Various factors, including unequal development of breast buds, endocrine disorders, chest wall deformities, and surgical or posttraumatic sequelae, can contribute to this condition. Although breast asymmetry is common, clinically severe cases are rare and often require surgical correction because of potential postural, aesthetic, and psychological issues. Accurate assessment of the breast volume is crucial for planning and evaluating surgical interventions. Methods This prospective, non-randomized, interventional study was conducted between 2019 and 2024 at the Breast Reconstruction Section of the Federal University of São Paulo, Brazil. Forty patients with breast asymmetry were evaluated using the BREAST-V, which calculates the breast volume based on three linear measurements. Patients underwent various surgical procedures, including augmentation, reduction mammoplasty, and mastopexy, tailored to their specific type of asymmetry. Preoperative and postoperative breast volumes were compared to assess the effectiveness of surgical correction Results The study included 40 participants, with an average age of 25.2 years. The mean preoperative breast volumes were 469.6 g (right) and 448.8 g (left). The postoperative volumes decreased to 338.3 g (right) and 331.1 g (left), showing an average reduction in asymmetry of 72.9%. The minimal clinically important difference (MCID) for pre-treatment asymmetry was 65.4 g. Conclusion The BREAST-V tool has significant potential for the objective assessment of breast asymmetry. Reliable volumetric measurements can aid in surgical planning and postoperative evaluation, ultimately enhancing the clinical outcomes. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Background: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder (BDD). Brazil stands as the global leader in the prevalence of labiaplasty procedures. This study aimed to assess alterations in genital self-image and symptoms of BDD in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty. Methods: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with 2 parallel groups. The allocation ratio was 1:1. The study group underwent wedge labiaplasty, and the control group underwent trim labiaplasty. Genital self-image and symptoms of BDD were assessed both preoperatively and 6 months postoperatively, using validated tools. Results: After a 6-month intervention period, a statistically significant improvement in genital self-image was observed (P < 0.001), alongside a marked decrease in the score of symptoms related to BDD (P < 0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique used. Conclusions: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of BDD, evident in both the wedge and linear labiaplasty groups at the 6-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Background: Symmastia, first defined by Spence et al. in 1984, is a medical condition characterized by the convergence of breast tissues in the midline, resulting in the absence of adhesion between the skin and subcutaneous tissue over the presternal area. It can be either congenital or acquired. Currently, there is no universally accepted treatment for symmastia. This study presents a surgical approach and preoperative and postoperative care for the correction of symmastia. Methods: Between January of 2014 and December of 2020, a surgical technique was performed on 100 patients, including 59 with congenital symmastia and 41 with acquired symmastia. The technique involved creating a thin skin flap and attaching it to the sternum to reconstruct the intermammary V-shaped region. Results: All patients in both groups underwent subglandular implant placement, with textured/polyurethane prostheses used in 97% of cases. Three cases did not use any implants. In the corrective surgery, patients received smaller, round implants, following the steps of the surgical approach devised by the author. The median satisfaction scores were high in both groups. Conclusions: The surgical approach described in this study is a safe, one-time procedure with a low risk of complications and high patient satisfaction. The technique is reproducible and provides consistent outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

The breasts are symbols of femininity, sexuality, and maternity. Breast augmentation is among the most sought-after procedures for women and has a positive impact on quality of life. Sexuality is one of the items that contribute to increased quality of life. Surgical outcomes can be evaluated from the patients’ perspective using developed and validated questionnaires. For the assessment of sexuality, the most commonly used instruments are the Female Sexual Quotient and the Female Sexual Function Index, which estimate several domains of sexuality and can be used to evaluate the impact of surgery on it.

Companies, markets, and consumption patterns are all part of daily life, particularly in health area. It is the responsibility of the pharmaceutical industry and patients to develop pertinent solutions (innovations) that are based on human needs. Design Thinking (DT) is a tool for innovating, and it should put people first. The answer has the power to transform people’s lives or address their problems. The purpose of this work is to propose DT concepts for application in health area innovation. Empathy, Collaboration, and Experimentation are the three primary pillars of Design Thinking, a human-centered paradigm of thought. The four steps of this innovative development technique are Discover, Define, Develop, and Commercialize. Discover, Define, Develop, and Deliver are the four distinct steps of this innovative development technique. The DT creative process is collaborative and incorporates consumers from the outset. Users of DT look for products that offer value that can be quickly tested, verified, and deployed on the market or for the user’s advantage. To vastly enhance the experiences of healthcare consumers, DT is broadly applicable in the field of health area and to all acts that directly or indirectly involve the prevention and/or treatment of illnesses. Because the major emphasis is on the individual/patient/customer/ service, combining this technique with conventional scientific methods might boost health innovation.

Background Breast augmentation with implants is the most commonly performed cosmetic plastic surgery in Brazil and worldwide. The aim of this study was to assess patient satisfaction and quality of life following subpectoral breast augmentation with either microtextured or macrotextured implants, using the BREAST-Q. Methods A prospective study was conducted with 40 women with hypomastia undergoing subpectoral breast augmentation. The patients were randomly allocated to two groups to receive either microtextured or macrotextured breast implants. All participants were assessed preoperatively (baseline) and after 2 and 4 months of surgery for quality of life and patient satisfaction with the surgical results, using the BREAST-Q augmentation module, a patient-reported outcome measure. Results The patients had a mean age of 28.9 ± 6.45 years. The microtextured (n = 20) and macrotextured (n = 20) groups were homogeneous for sex, age, education level, marital status, and number of children (p > 0.05). Both groups showed significant improvement in satisfaction with breasts (p < 0.001), psychosocial well-being (p < 0.001), and sexual well-being (p < 0.001) at the 2- and 4-month follow-up visits compared with baseline. The observed improvements were associated with high effect size values of 5.09, 3.44, and 3.90, respectively. In contrast, significant decreases from baseline in physical well-being scores (p = 0.001) were found 2 and 4 weeks after surgery in both groups. Conclusion Subpectoral breast augmentation with either microtextured or macrotextured breast implants improved satisfaction with breasts and quality of life in patients with hypomastia.

This study aimed to translate the BREAST-Q© - Breast Reconstruction Expectations Module (preoperative) 2.0 into Portuguese and adapt it to the Brazilian cultural context. Authorization for translation and cross-cultural adaptation of the questionnaire was obtained from the holders of the instrument's distribution rights. The questionnaire was translated and retro-translated. For cultural adaptation, the instrument was applied to 40 patients who had breast reconstruction surgery scheduled. Cronbach's alpha was used to assess the internal consistency. The mean age of the patients was 53.5 years, and the majority (72.5%) was undergoing reconstruction with implants. Good and excellent internal consistencies were observed for the Coping and Appearance expectations scales (Cronbach's alpha values of 0.878 and 0.909, respectively). For the Pain scale, the internal consistency was moderate (0.738), and it was acceptable (0.587) for the Medical team. The BREAST-Q© - Breast Reconstruction Expectations Module (preoperative) 2.0 was successfully translated and adapted to the Brazilian context.

Purpose: To compare JPEG and RAW image file extensions to direct measurement of the breast region. Methods: Points were marked on the breasts and arms of 40 female volunteers. The joining of these points in each hemibody formed seven linear segments, one angular segment and one median segment common to both hemibodies. Volunteers were photographed in a standardized fashion and evaluated by three raters using the software Adobe Photoshop CS6® and three image file extensions (RAW, high resolution JPEG and low resolution JPEG); values were compared to direct anthropometry. Results: All variables had interclass correlation coefficient higher than 0.8 (ICC>0.8). On average, all variables in all methods showed differences (p<0.05) when compared to direct measurement. A formula was created for each segment and each image file extension in comparison with the direct measurement. Conclusion: Measurements were similar among the correlated JPEG and RAW image file extensions but differed from the actual breast measurement obtained with a caliper.