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Introdução: O complexo areolopapilar (CAP) desempenha grande importância tanto na amamentação quanto na vida sexual das pacientes, consequentemente, devemos ressaltar que uma complicação potencial da mamoplastia redutora é a alteração ou até a perda da sensibilidade do CAP. Método: Estudo prospectivo, randomizado, controlado e duplo-cego para avaliar a relação entre a sensibilidade do complexo areolopapilar após mamoplastia redutora com liberação dérmica e o volume ressecado de tecido mamário. O estudo ocorreu no período de agosto de 2013 a agosto de 2015, no Hospital das Clínicas da Universidade Federal de Pernambuco (HC-UFPE). Resultados: O estudo totalizou 39 pacientes. A média de idade da amostra foi de 31,7 anos, índice de massa corporal (IMC) médio de kg/m2 e nenhuma das pacientes era tabagista. A taxa de comorbidade foi de 5,1% da amostra. O índice de complicações foi de 41%, composto de 7 casos de cicatriz inestética, 6 de hematoma e 4 de deiscência. Não houve caso de sofrimento ou necrose do CAP e todas as pacientes se mostraram satisfeitas com o resultado cirúrgico final. Não houve diferenças estatisticamente significantes em nenhuma das ocasiões entre os pacientes do grupo experimento e controle, tanto no grupo de ressecção de até 300 gramas quanto acima de 300gramas. Conclusões: A manobra de liberação dérmica não provocou diferença na sensibilidade do complexo areolopapilar, independentemente da quantidade de tecido mamário ressecado.

Introduction: The nipple­areola complex (NAC) plays an important role both in breastfeeding and sexual lives of the patients. Because of this, we must mention possible complications of reduction mammoplasty, such change or even loss of sensitivity of the NAC. Method: This was a prospective, randomized, controlled, double-blind study to evaluate the relationship between the sensitivity of the NAC after reduction mammoplasty with dermal release and the resected volume of breast tissue. This study was conducted between August 2013 and August 2015 at the Hospital das Clínicas of the Federal University of Pernambuco (HC-UFPE), in Recife City, Brazil. Results: The study involved 39 patients. The mean age and body mass index (BMI) of the patients were 31.7 years and 25.5 kg/m2, respectively. None of the patients was a smoker. The complication rate was 41%, including 7 cases of non-aesthetic scars, 6 cases of hematoma (bruises), and 4 cases of dehiscence. No patient had pain or NAC necrosis, and all the patients expressed being satisfied with the final surgical result. No statistically significant differences were found between the patients of the experimental and control groups, both in the group with resection of up to 300 g and those with resection >300 g. Conclusions: The maneuver of dermic release did not result in any differences in the sensitivity of the NAC, regardless of the quantity of resected breast tissue.

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Introdução: A manobra de liberação dérmica periareolar na mamoplastia promove uma melhor mobilidade do complexo mamilo-aréola (NAC). No entanto, existem dúvidas sobre possíveis danos nos nervos neste tipo de topografia. Este estudo objetiva uma análise quantitativa comparando a densidade dos nervos do fluxo lateral medial, lateral e caudal do NAC. Métodos: Trata-se de um estudo prospectivo. O estudo incluiu 26 pacientes do sexo feminino que foram submetidas à mamoplastia redutora pela técnica clássica de Pitanguy. Os fragmentos da derme coletados dos lados medial, lateral e caudal foram devidamente preparados e submetidos a um estudo histológico para determinar a densidade dos nervos em cada um dos lados estudados. Resultados: Dos 26 pacientes estudados, 42,3% apresentaram maior densidade de nervos no lado lateral; 38,5%, do lado medial e 19,2% do lado caudal. A análise estatística utilizada para avaliar se houve predominância de um lado onde a derme foi seccionada demonstrou que o teste de comparação de proporções não foi significativo (p = 0,304). Conclusão: A análise comparativa mostrou que não há preponderância de densidade de nervos em qualquer lado da derme periareolar.

Introduction: The periareolar dermal release maneuver in mammoplasty promotes better mobility of the nipple-areola complex. However, there are doubts on possible nerve damages in this kind of topography. This quantitative analysis compared the nerve branches density from the medial, lateral and caudal side-flow of the nipple-areola complex (NAC). Methods: This was a prospective study. The study included 26 women who have undergone a mammaplasty reduction using the Pitanguy's classic technique. The dermis fragments collected from the medial, lateral and caudal sides were properly prepared and subjected to a histological study in order to determine the nerve branches density in each studied sides. Results: Of 26 studied patients, 42.3% had a higher nerve branches density in the lateral side; 38.5%, on the medial side and 19.2% on the caudal side. The statistical analysis used to evaluate whether there was a predominance of one side where the dermis has been sectioned showed that the proportion comparison test was not significant (p = 0.304). Conclusion: The comparative analysis has shown that there is no preponderance of nerve density in any periareolar dermis side.

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BACKGROUND: Breast sensitivity preservation is among the aims of modern breast surgery. Large-volume resection, extensive undermining, and resections at the breast base have been associated with breast sensitivity alterations. The L short-scar mammaplasty technique is designed to preserve breast sensitivity by resection of tissue in the middle and inferior portions of the breast, but specifically dissection and preservation of the breast lateral neurovascular pedicle. Using this technique, a prospective study was designed for measurement of breast sensitivity quantitatively and subjectively to determine whether different resection volumes of the breast correlate with alteration of sensitivity postoperatively. METHODS: This study compared the sensitivity of 125 breasts of 64 consecutive patients who underwent mastopexy or breast reduction with the L short-scar mammaplasty technique. Nine points were tested with Semmes-Weinstein monofilaments: the nipple and cardinal points on the areola and skin. The tests were performed by the same examiner 1 day before surgery and then 6 and 12 months after surgery. The breasts were divided into three groups according to the resected volume as follows: group A (≤200 g), group B (201-400 g), and group C (>400 g). The patients also were asked to complete written surveys 12 months postoperatively, and the response rate was 100%. RESULTS: Before surgery, larger breasts were observed to have less sensitivity in the areola (groups B and C, P<0.001) and skin (group C, P<0.001). After 12 months, no correlation was found between larger resected volumes and less breast sensitivity. The sensitivity of the nipple-areola complex in all the groups reached levels equal to the preoperative measurement within 12 months after surgery. After 6 and 12 months, significant improvement in skin breast sensitivity with resections greater than 200 g (group B, P=0.002; group C, P<0.001) was observed. After 12 months, 66.4% of the patients and 94.4% of the group C patients (average resection, 499 g) reported equal or better nipple-areolar sensitivity compared with preoperative sensibility. No patient reported areas of areola or nipple insensitivity. CONCLUSION: After the L short-scar mammaplasty, breast sensitivity to pressure in most cases returns to preoperative levels or improves primarily in those with larger breasts. The data of this prospective study contradict the misconception that mammaplasty techniques with resections at the breast base leave the patient with reduced breast sensitivity because the fundamental neural pathways, such as the lateral neurovascular pedicle, are preserved.

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A reconstrução mamária pós-mastectomia vem crescendo e, com ela a necessidade de uma recuperação não apenas estética, mas também funcional do ponto de vista sensitivo. Sabemos que a sensibilidade de mama após reconstrução retorna parcialmente e em alguns casos não retorna. Este estudo objetivou enfatizar a importância da avaliação da sensibilidade da mama pós-reconstrução com tecido autólogo e promover uma discussão sobre necessidade da reeducação sensorial. Através de uma revisão bibliográfica foram apresentadas diferentes técnicas reconstrutoras, bem como diferente retorno sensitivo do retalho miocutâneo. Avaliações sensitivas encontraram retorno da sensibilidade do retalho entre um mês e três anos de pós-operatório. A reeducação sensorial tem sido proposta para melhorar a capacidade da paciente em interpretar o estímulo sensitivo. Apesar da variedade das formas de avaliação sensitiva encontradas neste levantamento, ficou claro que o retorno desta sensibilidade existe, mesmo em mamas que não foram reinervadas. Por isto, a importância de seu estudo bem como do planejamento futuro de técnicas de reeducação sensorial deve ser enfatizado pelos fisioterapeutas, pois refletem diretamente na aceitação subjetiva da neomama pela paciente, no retorno desta em seu prazer sexual e na prevenção de danos devido à insensibilidade.

The post-mastectomy mammals reconstruction has been increasing and with them comes the necessity not only aesthetic but also functional from the recovery sensitive point of view. It is known that the sensitivity of the post-reconstruction mama returns partially and in some cases it doens't return. This study aims to emphasize the importance of the evaluation of breast post-reconstruction sensibility with autologous tissue and to promote discussion about the necessity of sensorial reeducation. Through a bibliographic review, it was seen different reconstructions techniques, and also different sensory recovery in the myocutaneous flap. Sensibility evaluations found return of the sensibility in the flap between one month and three years post-operative. The sensorial reeducation has been proposal to improve the patient ability to interpret the sensory stimulus. Despite the variety of manners of sensory evaluation found in this poll, it became evident that the return of this sensibility exists even in breasts without nerve repair. Because of this, the importance of its study and also the future planning of sensory reeducation techniques, for reflecting straight on subjective acceptation of the new breast by the patient, by the return of it in his sexual pleasure an on injury prevention due to the insensibility.

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BACKGROUND: We describe a new method to study the sensibility of the nipple-areola complex of the breast with faradic electricity delivered through an electromyographic device used to monitor peripheral nerve conduction. METHODS: The objective results of faradic pulses (2-50 mA per pulse) delivered to the nipple-areola complex of the breast through a Nihon-Kohden II machine (Evoked potential/Electromyographs, Nihon-Kohden Co., Japan) were evaluated in normal volunteers to get a basal measure that was defined by the patient as "a soft electric discharge." The measures were recorded and their output discharges averaged (at least 5 to each complex). RESULTS: Twenty-eight volunteers with normal breasts, 28 patients with breast hypertrophy before and after breast reduction, and 28 patients before and after breast augmentation were studied. The faradic pulses were perceived from 1.5 to 3.5 mA in the areola and from 3 to 5.5 mA in the nipple in the control group and from 4.5 to 7.0 mA in the areola and from 6.5 to 9.5 mA in the nipple in the breast hypertrophy group with no significant changes before and after surgery. In the breast augmentation group the faradic pulses were very similar to the volunteers that had normal breasts, but 13 months after breast augmentation with silicone gel prosthesis, a difference was found because all the patients had a higher threshold and three cases had lost sensibility of the nipple-areola complex. CONCLUSION: In normal breasts the areola had a lower threshold for faradic pulses compared to the nipple. Hypertrophic breasts had a higher threshold to the faradic stimulation than normal subjects in the pre- and postoperative period. Hypoplastic breasts before breast augmentation had a perception threshold similar to that of the normal volunteers but after breast augmentation this perception was much higher.

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BACKGROUND: Recent studies have provided diverging results regarding the factors that may affect sensibility after primary breast augmentation. Implant volume is believed to be an important factor, but the relation of implant size to breast volume has not been adequately addressed. In addition, the literature shows that a conflict exists when the periareolar and inframammary approaches are compared. This study aimed to refine the volumetric analysis comparing the implant and final breast size as well as the intrinsic association of these two factors with postoperative sensory alteration of the breast. METHODS: A prospective study investigated patients who underwent aesthetic breast augmentation between June 2004 and October 2005 (i.e., a 16-month period) at the Ivo Pitanguy Institute. The sensibility in nine regions of the breast was tested before and after surgery using Semmes-Weinstein monofilaments. Breast sizers were used to compare the pre- and postoperative breast volumes. Statistical analysis of the data took into consideration the relative volume of the implant, the surgical approach, the presence of minor complications, the breast-feeding history, and the subjective evaluation of sensory changes in the patients. RESULTS: A total of 37 patients who underwent breast augmentation were examined preoperatively. The relative volume of the implant was found to be associated with sensibility alterations. No difference was found between the periareolar and inframammary incision approaches. Other factors such as previous breast-feeding, minor complications, and subjective alterations were not associated with sensory alterations. CONCLUSIONS: The study findings suggest that larger implants and smaller breasts show an increased association with postoperative sensory alterations of the breast. Plastic surgeons and their patients should be aware of this possibility. Implant volume should be considered together with breast size to avoid sensory complications, and this is summarized in the concept of relative volume.

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A preservação da sensibilidade da mama é uma das metas a seremalcançadas na moderna cirurgia de mama, mas a literatura sobre o assunto é escassa e contraditória. O objetivo desta pesquisa foi estudar prospectivamente a sensibilidade das mamas de 64 pacientes submetidas à técnica de mamoplastia com cicatriz curta em L. As mamas (n=125) foram testadas um dia antes da operação, seis meses e 12 meses depois, com os monofilamentos de Semmes- Weinstein. Foram testados nove pontos em cada mama: o mamilo, quatro pontoscardeais na aréola e quatro pontos cardeais na pele. As mamas foramclassificadas em três grupos, de acordo com o peso do tecido mamário excisado: grupo A, até 200 gramas; grupo B, de 201 a 400 gramas; grupo C, mais de 400 gramas. O teste de Kruskal-Wallis foi utilizado para comparar a sensibilidade das regiões da mama nos diferentes grupos, em períodos distintos. O teste de Friedman foi empregado para comparar a evolução da sensibilidade das regiões da mesma mama em diferentes períodos operatórios, separadamente em cada um dos grupos. Valores de p<0,05 foram considerados estatisticamentesignificativos. Descreveu-se a técnica de mamoplastia com cicatriz curta em L e manobras cirúrgicas para preservarem-se as divisões anteriores dos ramos cutâneos laterais dos nervos intercostais. Antes da operação, observou-se que a sensibilidade na pele das mamas foi menos intensa significativamente com o aumento da ptose mamária (graus I, II e III; p=0,021) e verificou-se, também, relação entre volumes mamários maiores e menos sensibilidade nas regiões daaréola (grupos B e C; p<0,001) e da pele (grupo C; p<0,001). Não se observou, 12 meses depois, relação entre maiores volumes excisados e menos sensibilidade mamária. Nos complexos aréolo-mamilares, todos os grupos alcançaram níveis de sensibilidade sem diferença significativa em relação aos níveis pré-operatórios, entre seis e 12 meses após a operação. Depois de seis e 12 meses, verificaram-se níveis de sensibilidade mais intensa significativamente na pele das mamas com excisões de mais de 200 gramas (grupo B; p=0,002 egrupo C; p<0,001). As pacientes também foram avaliadas subjetivamente, respondendo a questionário 12 meses após a operação. Do total, 89,1% informaram que a sensibilidade do complexo aréolo-mamilar não desapareceu nem mesmo nos primeiros dias de pós-operatório. Depois de 12 meses, nenhuma relatou áreas de insensibilidade na aréola ou no mamilo; 66,4% do total daspacientes e 94,4% das componentes do grupo C (média de excisão de tecido mamário de 499 gramas) descreveram sensibilidade da aréola e do mamilo melhor ou igual à sensibilidade pré-operatória. Concluiu-se que, após a mamoplastia com cicatriz curta em L, a sensibilidade mamária à pressão retorna aos níveis pré-operatórios ou melhora e que a maioria das pacientes fica satisfeita com a qualidade e a intensidade da sensibilidade na aréola e no mamilo, principalmente aquelas com mamas maiores.

Breast sensitivity preservation is one of the aims to be achieved bymodern breast surgery but the literature on the subject is scarce and contradictory. The purpose of this work was to prospectively study the breast sensitivity of 64 patients who underwent surgery with the L short scar mammaplasty technique. The breasts (n = 125) were tested one day before surgery, as well as six months and twelve months after it, with Semmes-Weinstein monofilaments. Nine points on each breast were tested: the nipple, four cardinal points on the areola and four cardinal points on the skin. Breasts were classified in three groups, according to the mammary tissue weight resected: group A up to 200 g, group B from 201 to 400 g and group C over 400 g. The ruskal-Wallis Test was used in order to compare breast region sensitivity in the different groups, in distinct periods. The Friedman Test was used to compare the evolution of sensitivity of the same breast in different operative periods in each group separately; p<0.05 values were considered to be statistically significant. The L short scar mammaplasty technique and surgical maneuvers carried out to preserve the anterior divisions of the lateral cutaneous branches of the intercostal nerves were described. Before surgery it was noticed that breast skin sensitivity was significantly less intense with the increase on breast ptosis (grades I, II and III; p=0.021). It was also noticed a relation between larger breasts volumes and less sensitivity in areola regions (groups B and C; p<0.001) and on skin (group C; p<0.001). Twelve months after surgery it wasnt observed a relation between larger resected volumes and less breast sensitivity. In nipple-areola complexes, all groups reached sensitivity levels without significant difference in relation to pre-operative levels, from six to twelvemonths after surgery. After six and twelve months, significantly more intense sensitivity levels on breast skin were verified in resections of more than 200 g (group B; p=0.002 and group C; p<0.001). Patients were also subjectively evaluated, answering a questionnaire 12 months after surgery. From the total, 89.1% reported that nipple-areola complex sensitivity didnt disappear even on the first days of the post-operative period. After 12 months, no patient reported areola or nipple insensitivity areas; 66.4% from the total of patients and 94.4% from group C patients (mammary tissue resection mean of 499 g) reported areola or nipplesensitivity equal to or better than pre-operative sensitivity. In conclusion, after the L short scar mammaplasty, breast sensitivity to pressure returns to pre-operative levels or improves and most patients get pleased with areola or nipple sensitivity intensity and quality, mainly those with larger breasts

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Previous work has shown that physiologic activation of the sympathetic system may inhibit milk yield (ME) in rats. Thus, adrenal catecholamines (CAs) are released by suckling, but it is not known whether such inhibition results also from reflex activation by the same stimulus of neural sympathetics upon the mammary gland. The present experiments were designed to determine whether suckling inhibits ME induced by oxytocin (OT) in the urethane-anesthetized lactating rat, and whether such inhibition results from adrenal and/or neurally released CAs. Rats were isolated (6 h) from their pups and then anesthetized. OT (0.8 mU every 2 min) was administered intravenously to the mothers during suckling. Rats were either chronically implanted with cannulae into the lateral cerebral ventricles (intracerebroventricularly), bilaterally adrenalectomized (ADX), hypophysectomized (HX), spinal cord transected (SCT: T3-T4), or had the nipple area (NA) locally anesthetized before suckling. MEs were low in control, sham, ADX and HX rats, but not in rats given the beta-adrenergic blocker propranolol (PROP; intravenously or intracerebroventricularly injected), nor in SCT, NA or PROP-HX rats. As revealed by ductal resistance measurements as an indicator of ductal tone, suckling-induced inhibition of ME was due to ductal constriction within the mammary glands. These effects of suckling, however, could be prevented by prior activation of ductal mechanoreceptors. Together, these results indicate that suckling inhibits ME through the reflex activation of neurally mediated central beta-adrenergic mechanisms, and that these effects, in turn, can be regulated by ductal mechanoreceptor activation.

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Electrical stimulation of the XIII thoracic nerve (the 'mammary nerve') causes milk ejection and the release of prolactin and other hormones. We have analysed the route of the suckling stimulus at the level of different subgroups of fibres of the teat branch of the XIII thoracic nerve (TBTN), which innervates the nipple and surrounding skin, and assessed the micromorphology of the TBTN in relation to lactation. There were 844 +/- 63 and 868 +/- 141 (S.E.M.) nerve fibres in the TBTN (85% non-myelinated) in virgin and lactating rats respectively. Non-myelinated fibres were enlarged in lactating rats; the modal value being 0.3-0.4 micron 2 for virgin and 0.4-0.5 micron 2 for lactating rats (P greater than 0.001; Kolmogorov-Smirnov test). The modal value for myelinated fibres was 3-6 micron 2 in both groups. The compound action potential of the TBTN in response to electrical stimulation showed two early volleys produced by the A alpha- and A delta-subgroups of myelinated fibres (conduction velocity rate of 60 and 14 m/s respectively), and a late third volley originated in non-myelinated fibres ('C') group; conduction velocity rate 1.4 m/s). Before milk ejection the suckling pups caused 'double bursts' of fibre activity in the A delta fibres of the TBTN. Each 'double burst' consisted of low amplitude action potentials and comprised two multiple discharges (33-37 ms each) separated by a silent period of around 35 ms. The 'double bursts' occurred at a frequency of 3-4/s, were triggered by the stimulation of the nipple and were related to fast cheek movements visible only by watching the pups closely. In contrast, the A alpha fibres of the TBTN showed brief bursts of high amplitude potentials before milk ejection. These were triggered by the stimulation of cutaneous receptors during gross slow sucking motions of the pup (jaw movements). Immediately before the triggering of milk ejection the mother was always asleep and a low nerve activity was recorded in the TBTN at this time. When reflex milk ejection occurred, the mother woke and a brisk increase in nerve activity was detected; this decreased when milk ejection was accomplished. In conscious rats the double-burst type of discharges in A delta fibres was not observed, possibly because this activity cannot be detected by the recording methods currently employed in conscious animals.(ABSTRACT TRUNCATED AT 400 WORDS)

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