RU2313287C1 - Method for making mammopexy - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves making circular incision bordering the areola. The second circular incision is produced some distance far from the previous incision determining in this way new areola position. Four fixing sutures are placed on skin along areola circle projection with the exception of the upper pole. Lower portion of the mammary gland is exposed to submammary fold and to its lateral and medial boundary. Hemostatic procedure is applied. A flap is cut out from polypropylene mesh shaped as hammock. The flap size matches the lower portion of the mammary gland from submammary fold to the lower areola boundary. The hammock mesh is fixed with its lower edge to subcutaneous fat cellular tissue and to greater direct thoracic fascia itself along submammary fold projection. on the upper boundary. The mesh is attached in lateral segments to greater direct thoracic fascia. The mesh is attached to subcutaneous fat cellular tissue along the lower areola boundary. Skin excess are excised around the areola and sutures are placed along its perimeter fixing it in new position.

EFFECT: reduced risk of traumatic intraoperative complications; preventing mastoptosis recurrence.

9 dwg

Description

The invention relates to medicine, namely to plastic and reconstructive surgery, and is used for operative mammopexy in ptosis of the mammary gland.

A known method for the correction of mastoptosis, including epidermization around the nipple-areolar complex, dissection of the skin and subcutaneous tissue along the concentric perimeter around the areola, changing the configuration of the mammary gland with a corrugating suture that spirally rises from the base of the mammary gland to the areolar edge, suturing the edges of the zone of epidermal deposition on corrugating dermal suture (Patent RU 2234260, published 08/20/2004).

This method is relatively traumatic, the tissue of the gland is injured, which is especially unfavorable for patients of childbearing age, the result obtained by correcting the position of the mammary gland can be unstable, when using this method relapses of mastoptosis can occur relatively often.

A known method for the surgical correction of mastoptosis, including de-epidermization of the skin around the nipple-areola complex, followed by intradermal sutures, is circular around the areola and horizontally along the submammary fold, while a bra-shaped frame is formed from the epidermal skin area, which is fixed from the lateral and medial sides the pectoralis major muscle and its fascia behind the distal ends of the flaps that make up the skeleton (Patent RU 2176481, published 10.12.2001).

This method more reliably fixes the mammary gland in a new position, however, it is also traumatic for the patient and in the remote period after surgery, relapses due to the gradual stretching of the formed skeleton are also possible.

In our method, a polypropylene mesh is used to fix the breast in a new position. Polypropylene implants in comparison with implants from other materials are low allergenic, non-oncogenic, have a high resistance to infection. Polypropylene implants are widely used in surgery, but so far they have not been used in operations on the mammary gland.

The use of a polypropylene mesh ensures the reliability of the fixation of the mammary gland in a new position and the prevention of possible recurrence of mastoptosis in the near and remote postoperative period.

This result - reliability of fixation, prevention of the risk of mastoptosis recurrence - is also achieved due to the features of the implant used from the polypropylene mesh used in our method: cutting a flap from a mesh that resembles a hammock, cutting this flap so that it matches the size of the lower part of the milk glands to the lower edge of the areola.

Also, to prevent the risk of recurrence of mastoptosis, it is necessary to fix the polypropylene mesh in a certain way: along its lower edge according to the projection of the submammary fold, in the lateral sections the mesh is fixed to the fascia of the pectoralis major muscle, along the upper edge of the mesh is fixed along the lower border of the areola.

This fixation of the flap in the form of a “hammock” supporting the mammary gland in a new position provides high reliability, preventing the risk of relapse, as well as low invasiveness for breast tissue.

Indications for surgery according to our method are:

1. Ptosis 3-4 degrees.

2. Sufficient (objective) mass of the breast, which contributes to the achievement of a good aesthetic result.

3. Reluctance of the patient to use the endoprosthesis of the gland.

4. Reluctance of the patient of any trauma to the glandular tissue.

5. The patient’s desire to have a minimal amount of postoperative scars.

The claimed method is as follows.

Before the operation, a thorough marking of the skin surfaces of the mammary glands, the anterior surface of the chest is carried out in order to fix the present position of the breast itself, the areolar complex and the future position of the breast as a result of the operation by our method.

The operation is performed under general anesthesia, although surgery is possible (under certain conditions and if there are any contraindications for general anesthesia) under local anesthesia. An infiltration anesthesia is made into the submammary space of the superficial gland tissue, near mammary tissue in the area of attachment of the pectoralis major muscle along the central line of the anterior surface of the chest and the anterior axillary line.

A circular section is made that borders the areola, and a second circular section, departing from the previous circular section, defines the new position of the areola. According to the markings, taking into account the correct comparison of tissues, 4 fixing sutures are applied to the skin along the projection of the areola circumference, with the exception of the upper pole, since the areola is fixed in a new, previously designated incision position. The lower part of the mammary gland is isolated to the submammary fold and to its lateral and medial borders. A thorough hemostasis is performed. From a polypropylene mesh, coarse-mesh, with good elasticity, a hammock-shaped flap is cut out, the flap corresponding to the size of the lower part of the mammary gland from the submammary fold to the lower edge of the areola.

For the same purpose, polypropylene yarns 2 (0) -3 (0) can be used, from which the formation of a “hammock” during the operation is possible. The areolar zone is fixed with holders (2 pieces), in addition to the previously held fixation in the upper pole. In this position, the glands are sewn to the latter with a hammock net. The mesh “hammock” is hemmed along its lower edge to the subcutaneous fat and the thoracic fascia proper (terminology according to SAPIN MR Human Anatomy, M., 1993, p. 260), covering the external intercostal muscles and ribs, according to the submammary projection folds, in the lateral sections the mesh is fixed to the fascia of the pectoralis major muscle, along the upper edge of the mesh is fixed to the subcutaneous fat on the lower border of the areola. The skin is distributed over the mammary gland and, since there are excess skin, excess skin is excised around the areola circumference and, if necessary, vertically towards the submammary fold. Sutures are placed around the areola, along its perimeter with a small pouch (for large excisions of the skin) or the usual nodular, fixing the areola in a new position. Necessarily active drainage and supporting, with moderate compression, bandage with elastic bandages with a preliminary aseptic bandage.

Our method allows you to eliminate ptosis of the mammary gland in the most gentle way, without any interest in the glandular tissue itself, without its trauma; our method allows you to give a new position to the mammary glands in a wide range, taking into account the patient's desire. Postoperative scars are obtained in a minimal amount.

We give clinical examples as an illustration.

Clinical example 1. Patient S., 32 years old. Diagnosis: ptosis of the mammary gland 3 degrees. The patient is offered an operation according to our method. The preoperative marking of the skin surfaces of the mammary glands, the anterior surface of the chest was carried out in order to fix the present position of the breast, the areolar complex and the marking of the future position of the breast, taking into account the patient's desire. The operation was performed under general anesthesia. A circular section was made bordering the areola, a second circular section, departing from the previous circular section, which determines the new position of the areola. The lower part of the mammary gland is isolated to the submammary fold and to its lateral and medial borders. Careful hemostasis. A hammock-shaped flap was cut from a polypropylene mesh. The flap is fixed. The excess skin around the areola was dissected, stitches were placed around the areola. A support bandage with moderate compression was applied with elastic bandages with a preliminary aseptic bandage. Monitoring the patient for 1.5 years: the aesthetic result is fully achieved, postoperative scars are minimal.

Clinical example 2. Patient S., 28 years old. Diagnosis: ptosis of the mammary gland of 4 degrees. Operation according to our method. The preoperative marking of the skin surfaces of the mammary glands, the anterior surface of the chest was carried out in order to fix the present position of the breast, the areolar complex and the marking of the future position of the breast, taking into account the patient's desire. General anesthesia. A circular section was made bordering the areola, a second circular section, departing from the previous circular section, which determines the new position of the areola. The lower part of the mammary gland is isolated to the submammary fold and to its lateral and medial borders. Hemostasis. A hammock-shaped flap was cut from a polypropylene mesh. The flap is fixed. The excess skin around the areola was dissected, stitches were placed around the areola. A support bandage with moderate compression was applied with elastic bandages with a preliminary aseptic bandage. Monitoring the patient for 1 year: the patient is satisfied with the aesthetic result, postoperative scars are minimal.

In addition to examples, we give illustrations to our method of operation.

Figure 1-2 - the patient's condition before surgery.

Figure 3 - preoperative marking of the skin surfaces of the chest

glands.

Figure 4-6 - stages of the operation.

7-9 - state in the postoperative period.

Claims (1)

The method of mammopexy including a circular incision bordering the areola, characterized in that a second circular incision is made, departing from the previous circular incision, determining the new position of the areola, 4 fixing sutures are applied to the skin along the projection of the areola circumference except for the upper pole, the lower part of the mammary gland is isolated to the submammary fold and to its lateral and medial borders, hemostasis is performed, a flap shaped like a hammock is cut from a polypropylene mesh, and the flap corresponds to the size of the lower h the mammary gland from the submammary fold to the lower edge of the areola, fix the mesh - “hammock” along its lower edge to the subcutaneous fat and the thoracic fascia proper according to the projection of the submammary fold, in the lateral sections the mesh is fixed to the fascia of the pectoralis major muscle, along the upper edge of the mesh fix to the subcutaneous fat along the lower border of the areola, excise excess skin around the areola, suture around the areola, fixing it in a new position.

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