Alexandre Mendonça Munhoz

Alexandre Mendonça Munhoz
Hospital Sirio Libanes · Department of Plastic Surgery

Doctor of Medicine

About

149
Publications
70,979
Reads
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2,309
Citations
Citations since 2016
53 Research Items
1173 Citations
2016201720182019202020212022050100150200250
2016201720182019202020212022050100150200250
2016201720182019202020212022050100150200250
2016201720182019202020212022050100150200250
Additional affiliations
November 2012 - present
University of São Paulo
Position
  • Head of Department
May 2012 - present
Sociedade Brasileira de Cirurgia Plastica
Position
  • Coordinator
January 2012 - present
Hospital Sirio Libanes
Position
  • Senior Researcher
Description
  • Professor, Post-graduation Programa (Master and Doctor), Surgical Techniques and Outcomes, Breast Surgery

Publications

Publications (149)
Article
Full-text available
Background: Autologous fat grafting (AFG) is a procedure indicated for breast augmentation (BA) to improve coverage of silicone implants and redesign breast shape. Different techniques are based on parameters such as intermammary distance and implant volume/projection, none of which have been systematically standardized according to the main areas...
Article
See the Original Article here. This study explored whether adipose tissue–derived stem cells (ADSCs) improve retention of autogenous fat grafts in hybrid breast augmentation (HBA).¹ This is a relevant topic because hybrid procedures offer unique features for treating patients who are candidates for breast augmentation (BA) but have a higher risk of...
Article
Full-text available
Kurz et al, express their concerns regarding the balance between the benefits and drawbacks of radio frequency identification device (RFID)-enabled breast implants. As indicated, this technology represents a higher level of traceability. Unlike typical product cards, the code in the RFID can never be lost or misplaced, providing accurate device tra...
Article
Background Laboratory and clinical research on breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is rapidly evolving. Changes in standard of care and insights into best practice were recently presented at the 3 rd World Consensus Conference on BIA-ALCL. Objectives The aim of this manuscript is to provide practice recommendations...
Article
Full-text available
Objective To present a systematic review of the literature and a meta-analysis evaluating the oncological safety of autologous fat grafting (AFG). Summary background data: AFG for breast reconstruction presents difficulties during follow-up radiological exams, and the oncological potential of grafted fat is uncertain. Previous studies confirmed tha...
Article
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Background: Reoperative augmentation mammoplasty (RAM) is a challenging procedure, with the highest rates of complications and revision. Complications include implant malposition, lateral displacement, bottoming out, and rotation. These deformities can be addressed with various procedures, but the pocket control and stability of the new smooth imp...
Article
Full-text available
Background Simultaneous association of autologous fat grafting (AFG) with silicone implants, defined as a hybrid procedure, has been proposed for breast augmentation (BA). In some patients, larger-volume implants may result in larger incisions, with long-term effects including implant palpability, soft tissue atrophy, and secondary ptosis. Some pat...
Article
Full-text available
Silicone 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...
Article
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Background and purpose: Breast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material. Materials and methods: Retrospe...
Article
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Background SmoothSilk implants (SSI) are the first generation of implants to incorporate a radio-frequency identification device (RFID-M), a non-invasive traceability system. Although the RFID-M is considered compatible with magnetic resonance imaging (MRI), the size of the artifact and its influence on breast tissue vary. This prospective study as...
Article
Background Simultaneous association of the axillary approach (AA) with the subfascial pocket (SF) has been proposed for breast augmentation (BA) surgery. New silicone implant technology and recent improvements in autologous fat grafting (AFG) have ushered in a new era for BA. Objectives This study presents the combined subfascial ergonomic axillar...
Article
Background Autologous fat grafting (AFG) has been used in surgical practice as a filling method. However, controversies remain on the specifics of this technique. So far, few relevant experimental large animal studies have objectively assessed factors related to AFG integration. Objectives This study uses an experimental medium-sized animal model...
Article
Background Although the transaxillary approach (TAA) is useful in primary breast augmentation (BA) surgery, drawbacks of this technique include the need to correct complications arising from reuse of the axillary incision. Objectives The purpose of this study was to assess the outcomes of secondary BA procedures performed via the TAA in a cohort o...
Article
Full-text available
OBJECTIVE. Breast tissue expanders with magnetic ports are MRI unsafe, preventing patients from benefiting from the diagnostic capabilities of MRI. A tissue expander was recently developed with a radiofrequency identification (RFID) port used for needle location and expansion that may be acceptable for a patient undergoing MRI. The purpose of this...
Article
Background Autogenous fat grafting (AFG) is an established technique used as an adjunct to breast augmentation (BA) to redesign breast shape. Surgeons often use experience and intuition to estimate AFG volume, which can result in incorrect assessment of donor areas and unnecessary fat removal. Objectives This study presents a method based on a mat...
Article
Background Single-stage augmentation mastopexy (SAM) is a common procedure, but revision rates are high. Muscle slings have been used in SAM, but despite satisfactory outcomes, most studies in the literature do not contain objective or accurate measurements of implant/breast position. This article describes a surgical technique for SAM using a comp...
Article
Full-text available
Breast 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® Implants (MSS) are the first t...
Article
Full-text available
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 associatio...
Article
Full-text available
Background: Autologous fat grafting has broad applications in reconstructive and aesthetic breast surgery as a natural filler and for its regenerative purposes. Despite the widespread use of fat grafting, there remains no shared consensus on what constitutes the optimal fat grafting technique and its oncological safety. For this reason, the author...
Article
Full-text available
Implant-based breast reconstruction (IBR) is the most common approach to reconstruct mastectomy deffects. Infection following breast recons- truction 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 i...
Article
Full-text available
Contact between silicone implants and skin/breast parenchyma has been described as an agent of implant contamination and biofilm formation, resulting in implant complications. The no-touch technique was introduced to avoid implant contact and reduce skin/breast contamination. The authors propose an easily available sleeve option using a saline ster...
Article
Full-text available
Introduction Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome c...
Article
Full-text available
Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therap...
Article
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Background Although general guidelines are available for established silicone gel breast implants, the unique characteristics of the latest Motiva implants warrant specific guidelines. Objectives This study aimed to generate consensus recommendations and summarize expert-based advice to better understand current surgical practices and to establish...
Article
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Background 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 umbi...
Article
Purpose/objective(s): To evaluate the role of surgical clips placement in the definition of boost treatment volume. Materials/methods: Clinical Target Volumes (CTV) were defined as: CTV Breast, CTV Quadrant (based on physical exam and pre-surgical images), CTV Boost, defined by clip plus margin (1 cm for 2 or more clips and 2 cm for 1 clip only)...
Article
This article presents an overview of intramuscular gluteal augmentation involving primary and secondary augmentation with implants. Although gluteal augmentation is a well-studied procedure, few reports have described the intramuscular technique or this technique in association with lipofilling. This article presents experience with a combined tech...
Article
Full-text available
Objective: to evaluate the role of age in the risk of postoperative complications in patients submitted to unilateral breast reconstruction after mastectomy, with emphasis on total reconstruction loss. Methods: we conducted a retrospective study of patients submitted to breast reconstruction, whose variables included: oncological and reconstruct...
Article
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Nanotechnology is defined as the design of products that interact with biological systems on the nanoscopic scale. Creating a controlled nanotexture and understanding the ways in which surface properties impact inflammatory response is of the utmost significance in designing implants that can provide satisfactory outcomes.
Article
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Purpose: 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...
Article
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The 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 e...
Article
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Introduction: Chest desmoid tumors (CDT) are rare lesions characterized by fibroblastic proliferation from the connective tissue. Although CDT have been studied previously, no cases following subfascial transaxillary breast augmentation (TBA) have been described. Presentation of case: The authors describe a case of CDT in a 28-year-old woman one...
Article
Background Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource c...
Chapter
The abdominal region is characterized as an esthetic functional unit that is relevant to define the body contour. Contour affections from the abdominal wall can cause significant alterations from the esthetic and functional point of view and have negative impact in the quality of life. Between the most frequent causes of contour alteration, we can...
Article
Background: Unsuccessful breast reconstruction management represents a complex challenge for the plastic surgeon. Although these events rarely occur, many patients are not suitable candidates for conventional flaps, because of either previous donor-site surgery or lack of sufficient tissue. Methods: In this study, a contralateral free latissimus...
Article
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Background: 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...
Article
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Background: 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 r...
Article
This 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 wit...
Article
Full-text available
PURPOSE: To investigate the effect of Botulinum toxin A (BoNTA) on skin flap viability in healthy, tobacco-exposed and diabetic rats. METHODS: Ninety male Wistar rats (250-300g) were randomly divided into six groups: control+saline (C1), control+BoNTA (C2), tobacco-exposed+saline (T1), tobacco-exposed+BoNTA (T2) diabetes+saline (D1) and diabetes+B...
Chapter
Currently, alternative incisions for breast augmentation have been described, and among the techniques available, the axillary approach has gained status as an attractive technique due to the aesthetic results and the scar placement in a less visible position. However, the future impact of the procedure on the lymphatic drainage patterns and sentin...
Article
This article presents an overview of the subfascial approach to primary and secondary breast augmentation with form-stable implants associated with autologous fat grafting. Although breast augmentation is a well-studied procedure, there are few previous reports concerning the subfascial technique and, especially, this technique associated with lipo...
Article
Full-text available
Nipple-sparing mastectomy (NSM) is a safe technique in patients who are candidates for conservation breast surgery. However, there is worry concerning its oncological safety and surgical outcome in terms of postoperative complications. The authors reviewed the literature to evaluate the oncological safety, patient selection, surgical techniques, an...
Article
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Lumbar triangle hernia after breast reconstruction with latissimus dorsi flap (LDMF) is a very rare complication and few cases were previously described. Muscle mobilization and iatrogenic fascia defect are related etiologic factors. The authors describe a rare case of lumbar hernia in a 58-year-old woman who underwent delayed left breast reconstru...
Article
Full-text available
Recently breast surgeons can offer patients a variety of treatment and reconstructive alternatives when early breast cancer is diagnosed. In fact, advances in reconstructive techniques have reduced surgical trauma and thus are capable of preserving the breast form as well as quality of life. Depending on a variety of different factors, including st...
Article
In microsurgical breast reconstruction, an adequate selection of recipient vessels is crucial for a successful outcome. Although the internal mammary (IM) vessels offer an attractive option, the internal mammary perforator (IMP) vessels are becoming a reliable alternative. The purpose of this study is to investigate the external diameters, lumen ar...
Article
Full-text available
Breast-conservation surgery (BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technic...
Article
Full-text available
To assess the viability of cultured epithelium and preserved by freezing for periods varying from one month to one year. Samples of cultured epithelium were incubated in cryoprotectant medium (Group A), packed in aluminum envelopes and packed in polystyrene boxes. The boxes were subjected to a temperature of-70ºC. After freezing for a period of tim...
Article
Full-text available
Breast-conservation surgery (BCS) is established as a safe option for most women with early breast cancer. Recently, advances in oncoplastic techniques have reduced surgical trauma and thus are capable of preserving the breast form and quality of life. In spite of the most BCS defects can be managed with primary closure, the aesthetic outcome may b...
Article
Full-text available
Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM...
Article
Breast sarcoma during pregnancy is an extremely rare event and represents a complex problem because of a more advanced stage at presentation. This report presents the first case of a 24-year-old woman with a gestational age of 20 weeks with a fast growing tumour in her left breast (29 × 19 × 15 cm) and infiltrating the skin/pectoralis muscles. Radi...
Article
Full-text available
To evaluate the role of pedicle occlusion on the viable area of a skin island flap. 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 postope...
Chapter
The nipple–areola complex (NAC) is an important component of the breast and its aesthetic outcome is crucial in most patients who have been diagnosed with breast cancer. The technical objectives of breast surgery are resection of the breast tissue with adequate margins while restoring the breast volume. To achieve these goals, numerous approaches h...
Article
Breast reconstruction with autogenous tissue is a well-established technique, but there are some limitations related to donor-site morbidity. Among available techniques, the superficial inferior epigastric artery (SIEA) flap is the least invasive procedure because it does not require harvesting or incision of the rectus muscle or the abdominal fasc...
Article
Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary cl...