JP4782824B2 - Soft tissue support - Google Patents

Description

  The present invention relates to a soft tissue support. Examples include, but are not limited to, human breast supports.

  Soft tissues such as human breasts tend to sink with age. The cause is weakening of the associated soft tissue support structure. In the case of a human breast, the support structure includes ligaments and breast skin.

  The skin encapsulating each breast supports the breast by suspending it from the area around the collarbone above it. With aging, the skin loses its elasticity and elasticity. Ligaments that support breast tissue from the inside also lose some of its elasticity with age. The loss of elasticity of the ligament overlaps with the loss of elasticity and elasticity of the breast skin, leading to weakening of the breast support structure. This causes a deformation of the breast shape called the breast drop. In practice, the weight of the breast tissue deforms the breast shape.

  There are a number of treatments and prostheses that are available to treat the breast drop. Some of them involve removing the skin and raising the breast. These treatments have a serious problem of scarring. This may cause scarring around, for example, the lower part of the nipple. Moreover, such treatment does not solve the original problem of weakening the breast support structure.

  Several artificial breasts have been developed to address the cosmetic challenges associated with breast aging. Some include regular breast augmentation implants, but this does not address the problem of breast drooping, but merely increases the breast. In some cases this treatment may be beneficial. However, breast implants do not raise the breast, but rather push it forward. If the patient already has a posterior breast drop, the sunk breast is simply pushed outward by the breast implant and does not rise.

  Several prostheses have been developed to raise the breast. Some of them are described, for example, in the following patent applications. FR 2682284 (Dessart); FR 2746298 (Bellity); US 4840629 (Silimed Silicone Instr Medic); WO 9704722 (Pignataro); and US 5217494 (Coggins et al).

  A problem common to these prostheses is that complex procedures are required to implant them. Of these prior art prostheses, for example those described in WO 9704722 and US 5217494, must be fixed directly to the patient's bones, in particular the ribs and clavicles. In order to attach the prosthesis in this manner, since a technique is required for using the screw, the cost is increased, and a long-time operation is required.

  Among other prostheses, according to those described in US Pat. No. 4,840,629, FR 2746298, FR 2682284, etc., a considerable incision is required when operating a patient. Usually, the breast skin is peeled off from the breast tissue and lifted so that the breast skin and the breast tissue are connected only by the areola. Subsequently, the prosthesis is inserted between the skin and breast tissue and sutured to secure it to the breast tissue. Thereafter, the skin is closed by stitching, leaving a considerable size of scar on the breast skin.

  A common problem with these prior art prostheses is that when the prosthesis is implanted, the prosthesis is fixed between the skin and the breast tissue, which makes correction very difficult. . A further issue with this task is that many of these prostheses must be implanted by relatively invasive procedures, making it extremely difficult to modify using existing prostheses. Can be mentioned.

  If the patient develops additional breast ptosis, the only realistic option is to repeat the same procedure. In this case, it is necessary to remove the existing prosthesis and implant a new prosthesis.

  There is yet another issue. After implanting the prosthesis, it is sometimes very difficult for the surgeon to manipulate the shape of the breast. In addition, it is extremely difficult for the surgeon to change and manipulate the site where the prosthesis is fixed. These are useful techniques for adjusting the shape of the breast. Therefore, when the surgeon adjusts the shape of the breast, the room for selection is extremely limited.

  In some prior art prostheses, the surgeon simply attaches the prosthesis to various attachment sites. In this case, satisfactory results are often not obtained because the shape of the breast is determined later by factors that the surgeon cannot control. Some prostheses can adjust the position of the prosthesis by moving the attachment site, but the movement is limited and allows the surgeon to fully manipulate the breast shape is not. This is a critical issue when the shape of the patient's breast is not symmetrical and the patient wants to correct it.

  In addition to these, there are also very realistic challenges with prior art artificial breasts. These are the points that the breast cannot be shaped alone and only supports the breast against the pectoral muscles. Prior art prostheses, at best, are just like very tight sports underwear. It crushes the breast and restricts movement, preventing the breast from maintaining its natural ideal shape.

  Although the above-described problem has been described by taking the breast drop as an example, the same problem exists in other types of soft tissues. Examples include buttocks, abdomen, facial skin, and the like.

  In addition, since the above-mentioned problems usually have cosmetic properties, it is necessary to select treatments to cope with them. In many cases, surgery to treat illnesses such as breast cancer requires the patient to undergo orthopedic surgery to minimize the visible effects.

  The objective of this invention is providing the soft tissue support body which solves at least one part among the subject mentioned above.

  According to the present invention, there is provided a mammalian soft tissue support comprising a biocompatible elastic layer of a predetermined shape having means for fixing the support subcutaneously.

  Furthermore, it is provided that the layer comprises means capable of operatively fixing the support relative to the recipient's sternum or a second chondro-sternal junction.

  Furthermore, it is provided that the layer comprises a mesh of elastic stretch members, wherein the mesh is preferably a mesh of strands of circular cross section, more preferably of polypropylene strands.

  Further, the means for fixing the support to the recipient is a suture, preferably an insoluble suture, and the suture is made through the fascia at the height of the second intercostal space, whereby the support is What is provided is fixed around at least one of the strands of the mesh.

In addition, the mesh is substantially L-shaped, or a U-shape, and a operable body inner leg operatively outer legs, more preferably wider than the body outer leg body inner leg Things are provided.

  Furthermore, what is provided on the support has at least one marking representing a cut line for operatively reshaping the support.

  Further, the marking is formed substantially parallel to the edge of the support, and the reshaped support defined by the marking has a predetermined size smaller than the support. Provided.

  Furthermore, it is provided that the support has a plurality of predetermined markings, each marking representing a unique cut line.

  Further provided is a marking that is heat-sealed to form an actuated edge and the support can be fixed subcutaneously using the edge after cutting.

  According to a further feature of the present invention, there is provided a soft tissue support system comprising a soft tissue support as defined above and an associated complementary template, wherein the template is substantially fluid impermeable. .

  An embodiment of the present invention will now be described with reference to the accompanying drawings, which are for illustration purposes only.

  A preferred embodiment of a soft tissue support according to the present invention is shown in the figure. In this embodiment, the support (1) is operatively formed and configured to support a female breast.

As shown in FIG. 1, the support (1) includes a substantially L-shaped layer (2) made of a biocompatible elastic mesh. L-shaped support (1) has a body outer leg (4) and body inner leg (3), the body outer leg (4) is slightly wider than the body inner leg (3).

  The mesh (2) has an outer peripheral part (5) that is heat-sealed. The mesh (2) is a synthetic mesh and is formed of polypropylene in this embodiment. The mesh (2) has a diamond-shaped open work structure (6), and each strand (7) of the mesh (2) is formed of polypropylene.

  The support (1) is operatively arranged so that the long side dimensions of each rhombus of the molded open work structure (6) are substantially from the top to the bottom with respect to the recipient's body. The short side of each rhombus of the open work structure (6) is substantially operatively arranged in a direction that intersects the mesh (2), in other words, horizontally.

  By setting the strand (7) in the diamond-shaped open work structure (6) in this direction, the support force by the support (1) is greater in the vertical direction than in the horizontal direction. The long side of the diamond-shaped open work structure (6) has a stronger resistance to deformation than the short side. This allows the support (1) to be resistant to gravity, which normally causes breast subsidence, while the breast is naturally Enlarging is allowed.

  To implant the support (1), the surgeon needs to expose the breast tissue. The type of treatment used depends on the patient's breast size and the amount of current breast drooping or subsidence.

  For patients whose breast cup size is between size B and size C and the breast droop is relatively small, the support (1) can be implanted through the access point around the areola. That is, the incision (8) is formed around the areola (9) as shown in FIG. This allows the nipple structure to remain completely intact and the remaining scars to be easily hidden along the outer circumference of the areola (9). As shown in FIG. 3, deep breast tissue (11) can be accessed by expanding the skin (10).

  As another measure, as shown in FIG. 8, a semicircular incision (12) is formed above the areola (13) and another incision (14) is formed in the lower breast fold (15). Also good. This procedure makes it possible to access breast tissue from two access points. The tissue above the nipple is accessible from a semicircular incision (13), and the region from above the lower breast fold to the nipple is accessible from the lower breast fold incision (14).

  In the case of a patient with a cup size of C or more and a large amount of drooping, it is usually necessary to reduce the breast simultaneously with the support (1) implant. In these patients, the surgeon typically requires greater access than is possible with the procedure described above. In such a case, as shown in FIG. 9, after an incision (16) is formed around the areola, an incision (17) is continuously formed toward the lower breast, and an incision (18) is further formed in the lower breast. ). This allows the skin to open and widen, thus ensuring sufficient access to breast tissue to perform breast reduction and subsequent implantation of the support (1).

  The procedure for implanting the support (1) will be described with reference to the incision (8) shown in FIG. 2 as an example, but any of the other surgical procedures mentioned may be used. These procedures are not special as long as the breast tissue is exposed, and can also be used for conventional breast surgery such as breast reduction, breast elevation, conventional breast implants filled with gel or saline, etc. Is.

  Referring to FIG. 2, the procedure begins by making an incision (8) around the areola. The general structure of the tissue that forms a female breast is schematically shown in FIG. As can be seen, there is a fat layer (20) under the skin (19), then the mammary gland (21), and finally the pectoral muscle (22).

  The purpose of this procedure is to implant the support (1) in the fat layer (20). The support (1) cannot be implanted directly under the skin (19). This is because part of the mesh strand (7) may be pushed out of the skin (19). Also, the support (1) cannot be directly implanted on the mammary gland (21). In order to implant at that location, the surgeon must sever the adipose tissue (20) from the gland, which should be avoided if possible. Therefore, the adipose tissue (20) is cut into two layers, the first layer (20A) remains attached to the skin (19), and the second layer (20B) covers the mammary gland (21). . After implanting the support (1) into the fat layer (20), the adipose tissue will dig into the mesh (2) and grow, and the mesh will be taken into the breast tissue.

Detaching fat layer (20) has a body-inside of the breast, carries out until the height of the second intercostal space (23) around, also performed around the breast (24). As a result, the fat layer covering the mammary gland is exposed, and the support (1) is fixed thereon.

  By using a system comprising the support (1) as an element, the surgeon can implant the support (1). This system comprises a support (1) and a complementary template (25) made from a sterile layer of plastic material. The template (25) is formed to accurately match the shape of the support (1), and when the support (1) is placed on the template (25), the edge of the support (1) is the template (25). It protrudes slightly from the edge part. The surgeon uses this template (25) to determine the optimal position of the support (1) on the breast tissue.

This is necessary because it is easier to move the template (25) over the fat layer (20B) on the mammary gland (21) than to move the support (1). Since the template (25) is formed from an elastic plastic material, it is not affected even if it comes into contact with body fluids. As shown in FIG. 3, after exposing the breast tissue, the breast tissue is captured using a template (25). The end (29) of the outer body leg (26) of the template (25) is placed in a position to fix the support (1), ie usually on the second intercostal space (23).

Subsequently, the base (27) of the L-shaped template (25) is stretched under the breast tissue to capture the breast tissue, and the distal end (30) of the inner body leg (28) of the template (25) is attached to the outer body leg (26). ) On the end (29). Since the body outer leg (26) is formed wider than the body inner leg (28), it is possible to support the breast tissue that may extend to the axilla of a patient.

The end (30) of the inner body leg (28) may extend over the end (29) of the outer body leg (26), which allows the surgeon to shape the breast (24). The support (1) forms a so-called hammock-like structure, which supports the breast tissue (11). The length of the support (1) that actively supports the breast tissue is determined by how much the end (30) of the inner body leg (28) is moved over the end (29) of the outer body leg (26). Is done. If used analogy hammock, by the amount of extending the ends (30) of the body side legs (28) on end of extracorporeal side legs (26) (29), the length of the hammock is determined.

It is also possible for the surgeon to adjust the angle at which the end (30) of the inner body leg (28) extends over the end (29) of the outer body leg (26). The orientation of the ends (29, 30) is usually at an angle of about 65 ° to each other. Here, the angle of 0 ° indicates that the ends (29, 30) are arranged in a completely aligned state and extend in the same direction. However, the surgeon can make this angle any angle between about 45 ° and about 90 °. This allows the surgeon to shape the breast (24) and move the nipple relative to the patient's rib cage (31).

As shown in FIG. 4, when the determined ideal orientation of the end of the body side legs (28) over end (29) of the extracorporeal side legs (26) (30), the support (1) the template (25) on To place. As a result, the support (1) can be arranged at a predetermined position and in a desired orientation, and contact with the body fluid at that time is limited to that derived from the underlying fat tissue (20B). Subsequently, the support (1) is fixed to the selected intercostal space (23) by stitching (32). Suture is performed through the end (35) of the outer leg (36) of the support (1) and the fascia of the intercostal space (23). Thereafter, the body of the support (1) is secured to the breast tissue under the template with surgical staples (33). Staples are applied from the edge (34) of the support (1) into the underlying fatty tissue (20B). Finally, the end (37) of the inner body leg (38) of the support (1) is sutured to the selected intercostal space (23) and the end (35) of the lower body outer leg (36).

  In this way, the support (1) is fixed in the patient's breast without being completely in contact with the patient's bodily fluid until the support (1) is fixed in place. The template (25) also aids the implant in that it provides the surgeon with an instrument to determine the required support (1) size. Prior to implanting the support (1), the surgeon can cut the template (25) to the correct size for the best fit. Once the correct size is determined, the support (1) can be cut to the same size as the template before implanting the support (1).

  After the support (1) is secured to the breast at its outer end and two ends, the template (25) is removed from under the support (1). This is done by pulling out the template (25) from the openings left along the inner edge of the support (1) around the areola (9), as shown in FIG.

  Once the support (1) implant is thus completed, the incision (8) may be closed by conventional surgical techniques.

  Of course, the embodiments described above are for illustrative purposes only and are not intended to limit the scope of the present invention. For example, any changes can be made to the support without departing from the scope of the present invention.

  The orientation of the support may be changed from a support that extends from a point above the breast to the bottom of the breast, with two ends overlapping on the breast, and a support with two or more ends overlapping under the breast. Is possible. In the case of such a support, a single end may be fixed on the breast, for example, two ends may be placed around the nipple and connected under the breast. In principle, the breast is still supported in a hammock manner, but the adhesion point to the breast and the adhesion point of the mesh to the mesh itself are different.

FIG. 1 is a plan view of a female breast support according to the present invention. FIG. 2 (FIG. 2) is a diagram showing a female breast in a state where an incision has been made around the areola in order to make the prosthesis of FIG. 1 implantable. FIG. 3 is a diagram showing a state in which the skin around the areola is expanded to allow access to the breast tissue in the breast of FIG. 2, and the prosthetic template is placed at a predetermined position on the breast tissue. is there. FIG. 4 (FIG. 4) is a diagram showing a state in which the prosthesis is placed on the template and fixed to the fascia and breast tissue of the second intercostal rib. FIG. 5 (FIG. 5) is a diagram showing a state where the template is pulled out from under the prosthesis. FIG. 6 (FIG. 6) is a diagram showing a state where the template is pulled out from under the prosthesis. FIG. 7 is a cross-sectional view of the skin and breast tissue of a prosthetic recipient. FIG. 8 shows an incision in another process for implanting a prosthesis. FIG. 9 is a diagram showing an incision in another process for implanting a prosthesis.

Claims (19)

A mammalian soft tissue support, comprising a biocompatible elastic layer of a predetermined shape having means for fixing the support subcutaneously, and a base and an actuating type extending substantially perpendicular to each other from the base A mammalian soft tissue support having an inner body leg and an actuating body outer leg, wherein the width of the outer body leg in the longitudinal orthogonal direction is larger than the width of the body inner leg in the longitudinal orthogonal direction . The support of claim 1, wherein the layer is generally L-shaped. The support of claim 1, wherein the layer is generally U-shaped. 4. A support according to any one of claims 1 to 3 , wherein the layer comprises a mesh of elastic stretch members. 5. A support according to claim 4, wherein the layer comprises a mesh of circular cross-sectional strands. The support according to claim 4 or 5, wherein the elastic extension member comprises a strand of polypropylene. Said means for the support and fixed with subcutaneous, wherein comprises a terminal on the edge of the body inner leg of the supporting body, the muscle around either of said body inner leg ends first to third intercostal space to be secured to actuated the film, the body suture through the inner leg ends and the fascia is made, support according to any one of claims 1 to 6. It said means for the support and fixed with subcutaneous, wherein comprises a terminal on the edge of the body outer leg of the support, muscle around either of said body outer leg ends first to third intercostal space to be secured to actuated the film, wherein the body outer leg ends of the support, wherein the fascia, and the body suture through inner leg ends are made, according to claim 7 support according. The means for fixing the support subcutaneously has an edge on the outer periphery of the support and is sutured through the edge into the deep breast tissue such that the edge is operatively fixed to the deep breast tissue or 9. A support according to claim 7 or 8 , wherein staples are made. The support according to any one of claims 7 to 9 , wherein an edge of the layer is heat-sealed. The support according to any one of claims 7 to 10 , wherein an edge of the layer is folded. 12. A support according to any one of claims 7 to 11 having at least one marking on the support that represents a cut line for operatively reshaping the support. 13. The marking according to claim 12 , wherein the marking is formed substantially parallel to an edge of the support, and the reshaped support defined by the marking has a predetermined size smaller than the support. The support described. 14. A support according to claim 13, comprising a plurality of predetermined markings, each marking representing a unique cut line. 15. A support according to any one of claims 12 to 14, wherein the marking is heat fused to form an actuated edge, and the support can be fixed subcutaneously using the edge after cutting. A mammalian soft tissue support system comprising the support according to any one of claims 12 to 15 and a template having a shape complementary to the support. The system of claim 16, wherein the template has a dimension that is complementary to a dimension of the support. The system of claim 17, wherein the template has the same dimensions as the dimensions of the support. 19. A system according to any one of claims 16 to 18 wherein the template is made from a sterilizable elastic plastic material.

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