RU2217071C2 - Surgical method for treating gynecomastia vera - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves making straight or semioval incision along submammary fold. Skin is separated together with nipple and areola to reticular dermal layer. Mammary gland is removed together with adjacent fat and greater thoracic muscle fascia. The residual cavity is drained with active drainage. The postoperative wound mouth edge is sutured using intracutaneous suture. The active drainage is removed at the 3-4-th day and the intracutaneous suture at the 7-8-th day after operation. EFFECT: accelerated healing; improved cosmetic result.

Description

 There is excision of the breast with preservation of the nipple (Bogoraz N.A. Reconstructive surgery, - Rostov-on-Don: Rostizdat, 1940, p.541), husking of the breast with preservation of the nipple (Holdin S.A. Surgery Manual, Medgiz, I960, v. 5, p. 255-257).

 These methods do not reveal the technical details of the operation.

 When performing an operation for true gynecomastia, the following surgical incisions were proposed: for a small tumor - a transareolar incision, for a large tumor - an incision along the submammary fold (Zoltan J. Cicatrix optima, operating technique and conditions for optimal wound healing. Academia Kiado, publisher of the Hungarian Academy of Sciences, Budapest 1977, pp. 136-137).

 However, when performing a transareolar incision, the subareolar lymphatic collector collects lymph from the anterior glands and skin of its central parts, sensitive fibers of IV-VI pairs of intercostal nerves, forming the subareolar nerve plexus, which leads to disruption of both lymph drainage and innervation of the nipple-areolar region complex.

 Closest to the technical nature of the proposed method is the method of removal of breast tissue (Chukhrienko DP, Lyulko AV Atlas of operations on the mammary gland, "Health", Kiev, 1971, p. 96). Surgery is performed through the following incisions: a radial skin incision, an arched skin incision along the lower edge or along the lateral edges of the gland, a section along the outer edge of the pectoralis major muscle. With significant tumor sizes, a racket incision is used.

 After the cut, the skin along with the nipple and areola is separated to the side. In a sharp and blunt way, the iron is separated from the thoracic fascia and removed. Excess skin is excised. Stitches are applied to the skin. The edges of the wound to avoid necrosis are not tightened tightly. Through an additional incision, a PVC pipe is inserted for one to two days.

 However, the preservation of the thoracic fascia makes it difficult to grow the separated skin flap to the pectoralis major muscle, and therefore the process of complete healing of the postoperative wound is delayed. When applying nodular skin sutures, the probability of necrosis of the edges of the wound is high. Passive drainage of the postoperative wound cavity, the sizes of which can vary from 3-4 to 10-15 cm in diameter, is fraught with infection of the wound and accumulation of exudate (the amount of which reaches from 5-10 to 40-60 ml per day), which complicates the healing of the separated skin flap to the pectoralis major muscle. Including this method creates pronounced inconvenience for the patient in the early postoperative period due to the need for compression of the chest bed, the flow of exudate directly to the dressing, which leads to maceration of the skin, as well as physical and mental discomfort.

 The task was set to quickly heal the postoperative wound, adherence to the cosmetic effect and improve the quality of life of the patient by facilitating the early postoperative period.

 A method of treating true gynecomastia involves separating the skin along with the nipple and areola, removing the breast, hemostasis, draining the wound cavity and suturing the wound.

Tactics for performing true gynecomastia surgery
Depending on the size of the tumor, surgery is performed under general or local infiltration anesthesia. For small breast sizes, local anesthesia is preferred because anesthetic injection allows hydraulic preparation of the gland from the skin.

 On a submammary fold, a semi-oval or straight skin incision is made.

 Separation of the skin is carried out together with the nipple and areola up to the reticular layer of the dermis, the breast tissue is removed along with the adjacent fatty tissue and fascia of the pectoralis major muscle.

 During the operation, hemostasis is performed. The drainage of the residual wound cavity is carried out due to the sewn hem catgut to the pectoralis major muscle and active drainage removed through a separate puncture of the skin.

 Suturing the edges of the postoperative wound is done by applying an intradermal suture.

 Active drainage is removed for 3-4 days, the intradermal suture - for 7-8 days after surgery.

The operations performed by the proposed method in 20 patients with true gynecomastia showed the following advantages:
1. The period of the expiration of wound fluid (exudate) is limited to 3-4 days.

 2. The nature of the exudate remains serous, rarely serous-hemorrhagic.

 3. When active drainage is removed, almost complete fusion of the separated flap of the skin with the pectoralis major muscle is noted.

 4. There is no cicatricial deformity, hyperpigmentation and edema of the nipple-areolar complex.

 5. Normal nipple sensitivity is maintained.

 6. There is a marked decrease in the duration and intensity of the pain syndrome.

 7. There is no necrosis of the edges of the skin.

 8. The postoperative period becomes more comfortable due to the lack of free flow of exudate to the wound dressing and the need for compression of the chest bed.

 9. The period of temporary disability of patients undergoing surgery for true gynecomastia is reduced by an average of 4-7 days.

Claims (1)

A method of treating true gynecomastia, including separating the skin along with the nipple and areola, removing the breast, hemostasis, draining the wound cavity and suturing the wound, characterized in that they make a semi-oval or direct incision along the submammary fold, separate the skin to the reticular layer of the dermis, remove the mammary gland together with the adjacent fatty tissue and fascia of the pectoralis major muscle, drain the residual cavity with active drainage, suture the edges of the postoperative wound with an intradermal suture, remove active drainage and 3-4 hours, and intradermal seam - for 7-8 days after surgery.