Introdução: Existe um interesse e uma demanda crescente de treinamento oncoplástico (OP) e cirurgia reconstrutiva por cirurgiões de mama. No entanto, até agora tem faltado um modelo específico de treinamento neste campo na maioria dos países, sem dados com relação à curva de aprendizado. A Mastologia tem sido uma especialidade médica no Brasil desde 1978. É totalmente dedicada a estudar, prevenir, diagnosticar e gerenciar todas as doenças da mama. A incorporação de OP e cirurgia reconstrutiva na Mastologia apresenta uma série de desafios, e há algumas questões controversas a serem superadas. Objetivo: O objetivo deste estudo, portanto, foi analisar como a OP e as técnicas reconstrutivas estão sendo incorporadas no treinamento cirúrgico em Mastologia no Brasil. Métodos: uma pesquisa específica foi projetada para cobrir todos os residentes cirúrgicos que concluíram seu programa regular em Mastologia no Brasil em 2015 e 2016. Resultados: Foram incluídos 124 residentes de 49 unidades mamárias, com a maioria treinada durante todos os 2 anos de residência, conforme recomendado pela Sociedade Brasileira de Mastologia. Além disso, a maioria dos entrevistados foi capaz de realizar reconstruções e reconstruções mamárias parciais usando expansores e implantes. Mas ainda 20% deles apresentaram falta de treinamento específico nestas técnicas. Conclusão: uma vez que o controle local adequado da doença e da qualidade de vida está relacionado às decisões cirúrgicas, espera-se que os cirurgiões de mama ampliem seus limites e responsabilidades para melhorar a realidade da maioria dos pacientes com câncer de mama. PALAVRAS-CHAVE:Reconstrução mamária; cirurgia oncoplástica; educação médica; neoplasias de mama. RESUMO ABSTRACTIntroduction: There is a growing interest in, and an increasing demand for, oncoplastic (OP) and reconstructive surgery training by breast surgeons. However, until now there has been a lack of a specific model for training in this field in most countries and no data with respect to learning curves. Mastology has been a medical specialty in Brazil since 1978. It is fully dedicated to studying, preventing, diagnosing, and managing all diseases of the breast. Incorporation of OP and reconstructive surgery in Mastology presents a number of challenges, and there are some controversial issues to overcome. Objective: The purpose of this study, therefore, was to analyze how OP and reconstructive techniques are being incorporated into surgical training in Mastology in Brazil. Methods: A specific survey was designed to cover all surgical residents who concluded their regular program in Mastology in Brazil in 2015 and 2016. Results: One hundred twenty-four residents from 49 breast units were included, with the majority having their training for all 2 years of their residence, as recommended by the Brazilian Society of Mastology. In addition, most of the respondents were able to perform partial breast reconstructions and reconstructions using expanders and implants, but 20% of them had a lack of specific training in these...

Introduction: In addition to a surgical option, the oncoplastic surgery (OP) is a new philosophy in the mammary oncologic therapy, since it combines concepts of oncologic surgery and plastic surgery. There was a concern that plastic surgery techniques would compromise the oncologic radicalism, leading to an increased risk of tumor recurrence and damage to the patients' survival. The main purpose of the breast conservative surgery (BCS) is to obtain disease-free surgical margins, with a great esthetic-functional result. However, since the advent of this approach, the search for negative margins has been a problem. Despite the efforts to avoid compromised margins, they occur in 20 to 40% of the cases in the traditional BCS, and in many cases leading to the need of reexcision or even to mastectomy. Objective and method: In the analysis of recent studies, the OP role as a reduction factor of new surgeries and local recurrence is questioned. The aim of this paper is to analyze it based on literature review. Conclusion: According to recent studies, the OP became a safe oncological surgical technique that improves both the esthetic result and the disease local control, decreasing the compromised margins with impact on the mitigation of new surgeries rate.KEYWORDS: Mammoplasty; Local recurrence of neoplasia; Reoperation; Margins of excision; Segmental mastectomy. ABSTRACT RESUMOIntrodução: A cirurgia oncoplástica (OP) além de opção cirúrgica é uma nova filosofia no tratamento oncológico mamário, pois combina os princípios da cirurgia oncológica com os da cirurgia plástica. Existia um temor de que as técnicas de mamoplastias redutoras pudessem comprometer a radicalidade oncológica, levando a um risco aumentado para recidivas tumorais e prejuízo na sobrevida das pacientes. O objetivo primário da cirurgia conservadora de mama (CC) é obter margens cirúrgicas livres de doença, com bom resultado estético-funcional. Entretanto, desde o advento dessa abordagem, a busca por margens negativas tem sido problemática. Pois, apesar do esforço para se evitar margens comprometidas, elas ocorrem em 20 a 40% dos casos na CC tradicional, levando, em muitas situações, à necessidade de reexcisão ou até mesmo mastectomia. Objetivo e método: Analisando estudos recentes, questiona-se o papel da OP como um fator redutor de reoperações e recidiva local. O objetivo desse artigo é fazer uma discussão embasada em revisão da literatura. Conclusão: Conforme estudos recentes, a OP consagrou-se como técnica cirúrgica oncologicamente segura, com melhora tanto no resultado estético como no controle local da doença, diminuindo margens comprometidas e impactando na atenuação da taxa de reoperações.

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Objective: Breast surgery is considered a clean surgery; however, the rates of infection range between 3 and 15%. The objective of the present study was to intraoperatively investigate the presence of autochthonous microbiota in the breast. Methods: Pieces of breast tissue collected from 49 patients who underwent elective breast surgery (reconstructive, diagnostic, or oncologic) were cultured. The pieces of breast tissue were approximately 1 cm in diameter and were removed from the retroareolar area, medial quadrant, and lateral quadrant. Each piece of tissue was incubated in brain heart infusion (BHI) broth for 7 days at 37°C, and in cases in which the medium became turbid due to microorganism growth, the samples were placed in Petri dishes for culturing and isolating strains and for identifying species using an automated counter. Results: Microorganism growth was observed in the samples of 10 of the 49 patients (20.4%) and in 11 of the 218 pieces of tissue (5%). The detected species were Staphylococcus lugdunensis, Staphylococcus hominis, Staphylococcus epidermidis, Sphingomonas paucimobilis, and Aeromonas salmonicida. No patient with positive samples had clinical infection postoperatively. Conclusion: The presence of these bacteria in breast tissue in approximately 20% of the patients in this series suggests that breast surgery should be considered a potential source of contamination that may have implications for adverse reactions to breast implants and should be studied in the near future for their oncological implications in breast implant-associated large-cell lymphoma etiology.