RU2416370C1 - Method of mammary gland plasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to reconstructive and plastic surgery of mammary gland (MG), including treatment of MG cancer. Plasty of mammary gland is carried out by means of endoprosthesis, endoprosthesis is placed into a bag from absorbable vicryl mesh, which is tightened at the top. The bag is fixed with interrupted sutures to surrounding tissues of mammary gland, upper pole being fixed to functioning greater pectoral muscle.

EFFECT: method makes it possible to apply endoprostheses of large size, prevent ptosis of formed gland, compensate missing tissues, as well as prevents endoprosthesis migration and ensures complete fitting of prosthesis to surrounding tissues.

2 dwg, 1 ex

Description

The invention relates to medicine, namely to reconstructive and plastic surgery of the mammary gland (MF), including in the treatment of breast cancer.

There are a number of methods for using endoprostheses of various sizes to increase MF for aesthetic reasons, as well as during reconstruction of the gland after resection or radical mastectomy for cancer (RU No. 2177265, RU No. 2180803). One of the main stages of the known methods is the formation of the bed - the "pocket" in which the endoprosthesis is placed. The walls of the “pocket” can be fragments of the displaced latissimus dorsi, fascia of the pectoralis major muscle, adjacent mammary tissue, submammary fold. A disadvantage of the known methods of breast plastic surgery is the high probability of possible complications: prolapse of the walls of the pocket with the prosthesis, pressure sores, displacement of the prosthesis. The reason for these complications is the insufficient strength of the walls of the "pocket" and / or lack of tissue to form the walls, especially with large volumes of the prosthesis.

Closest to the claimed invention in terms of features is a method of mammopexy, during which excess skin and gland tissue around the areola are removed. In this case, the nipple-areolar complex with the underlying tissue is raised to a predetermined position, a flap in the form of a hammock is cut from a polypropylene mesh, which is fixed under the areola and to the fascia of the pectoralis major muscle in the projection of the submammary fold (RU No. 2313287). Adopted as a prototype.

The disadvantages of the prototype method that impede the achievement of the following therapeutic results are a significant limitation of use - with ptosis 3-4 degrees and / or with a large size of the breast.

The invention is aimed at solving the problem of improving the effect of reconstructive and plastic surgery of the breast, including in the treatment of cancer.

Using in clinical practice the proposed method allows to achieve several technical (therapeutic) results:

- improving the aesthetic results of reconstructive plastic surgery,

- prevention of possible complications at various times of the postoperative period - pressure sores, prolapse, loss or displacement of the endoprosthesis.

In addition, when performing various operations, it is possible to achieve various technical (medical) results, namely:

In plastic surgeries performed for an aesthetic purpose - augmentation mammoplasty, correction of the shape of the gland, mastopexy:

- the possibility of using large endoprostheses,

- prevention of ptosis of the formed gland by fixing the mesh container with the endoprosthesis to static tissues - pectoral muscles (chest wall),

- compensation of missing tissues with a mesh during the formation of the endoprosthesis bed,

- prevention of endoprosthesis migration in various directions,

- the possibility of a snug fit of the prosthesis to the surrounding tissues due to fixation of the mesh to adjacent tissues with the required number of seams through the mesh cells;

with skin-saving reconstructive surgery for cancer:

- reducing the duration of anesthesia, blood loss, trauma, preservation of donor tissue due to the fact that there is no need to move the back muscles and other areas in order to form the walls of the endoprosthesis bed of the breast,

- the possibility of using a large breast endoprosthesis of large size, regardless of the surgical possibilities of using donor auto- and allotissues;

in case of radical mastectomy with simultaneous reconstruction of the MF with a displaced skin-subcutaneous-muscle flap of the back or abdomen:

- saving of the volume of moved donor tissues, the task of which is only to close the defect, due to the fact that the necessary tissue deficiency is compensated with the help of an endoprosthesis,

- the ability to reconstruct large breast with a minimal risk of ptosis, pressure sores of the walls.

These technical (therapeutic) results in the implementation of the invention are achieved due to the fact that, as in the known method, plastic breast is carried out by fixing the mesh of biocompatible material to the soft tissues of the breast.

A feature of the proposed method lies in the fact that the plastic of the breast is carried out using an endoprosthesis enclosed inside the container from an absorbable vikrilovogo mesh, which is fixed with interrupted sutures to the surrounding tissues of the breast.

The invention consists in the following.

The most common in reconstructive plastic surgery are operations, during which it is necessary to either increase the size of initially small breasts in healthy women, while solving mastopexy and aesthetics, or restore the volume and shape of the glands changed during breast cancer operations.

For a successful endoprosthetics result, it takes about 3 months of uncomplicated postoperative course for the body to form a capsule around the prosthesis. However, the walls of the formed “pocket” often do not withstand the pressure of the endoprosthesis, become thinner, scarring, lose elasticity, and, as a result, the necessary fibrous capsule around the prosthesis does not have time to form and the prosthesis can shift down or sideways, until it completely falls out when a pressure sore and skin necrosis. Another extreme is also possible - the absence of the necessary ptosis due to the rigidity of the displaced muscle, its subsequent atrophy and the development of scar tissue, as a result of which pronounced asymmetry of the breast remains, causing gross aesthetic disturbances.

The inventors have developed a method for breast plastic surgery, according to which the endoprosthesis of the required volume and shape is placed in a container, which is a mesh bag of absorbable vikrilovy thread, which is tightened in the form of a loop on top and in this form is fixed with interrupted sutures to the chest wall in the required area. Presented in Figure 1 (photo). Fixation of the upper pole of the container to a functioning (“live”) pectoralis major muscle, the location and fixation of which does not change significantly with age, leads to the fact that the main burden of maintaining the location of the endoprosthesis in the period preceding capsule formation lies on the pectoral muscles. Numerous mesh cells of the container serve to fix the container with the endoprosthesis inside it to the stored breast tissues, reaching the necessary direction of the formation of the walls of the "pocket". Outside the endoprosthesis is covered by the skin of the breast with subcutaneous tissue and, possibly, a thin layer of glandular tissue. There is no need to use donor muscle autografts and polypropylene nets to strengthen individual fragments of the walls of these autografts.

The claimed invention can be used with all variants of plastic surgery with endoprosthetics of the breast without restrictions - regardless of the size of the gland, degree of ptosis, diagnosis and pathology of the breast.

The method is as follows.

A skin incision is made, the tissues of the retroammammary space are separated (and removed with cancer). A silicone round endoprosthesis is placed in a container - a bag of absorbable vikrilovogo mesh, the size of which corresponds to the size of the endoprosthesis. The container is tightened in the form of a loop on top and in this form is fixed with interrupted sutures to the chest wall in the required area. Through mesh cells, the container is fixed with interrupted sutures to the surrounding breast tissue.

The scheme of fixation of the container to the chest wall and surrounding breast tissue is presented not Figure 2, where are indicated:

- 1 - breast prosthesis

- 2 - mesh container

- 3 - chest wall

- 4 - breast skin with a subcutaneous layer

- 5 - mesh fixation points with interrupted sutures

Execution examples

Patient J., 34 years old, was treated in the 4th surgical department of the Moscow P.A. Herzen from 04/06/09 to 04/24/09. Diagnosis: Left breast cancer IIA stage T2N0M0. Concomitant pathology: peptic ulcer of the duodenum (remission). Chronic gastroduodenitis. Condition after RFA of the conduction system of the heart in 1999. Atrial extrasystole.

Upon admission to MNII: MF small size (N 1-2 for a bra). A tumor 2 × 2.5 cm in size is located on the border of the upper quadrants.

04/15/09 a volume operation was performed - subtotal subcutaneous resection of the left breast with plastic silicone endoprosthesis (v-150 ml, Mentor) in a container made of VM102 vikrilovoy mesh (18 × 10 cm). Under intravenous anesthesia (spontaneous breathing), two semi-oval cuts made a skin incision from the areola to the axillary region, without going beyond the front axillary line. About 85% of the gland tissue has been removed. Subcutaneous tissue and gland tissue are mostly left in the submammary fold. The edges of the pectoral muscles, subclavian vein are highlighted. The subclavian-axillary and intramuscular tissue was removed in a single block. A 150 ml Mentor silicone round endoprosthesis is placed in a container - a 18 × 10 cm vicryl mesh bag, which is looped from above and fixed with interrupted sutures to the pectoralis major muscle in the projection of the 2nd intercostal space, symmetrically to the contralateral gland. Through the mesh cells, the container is fixed with interrupted sutures to the remaining remaining breast tissue. The wound is sutured in two rows of sutures - subcutaneous tissue and skin. The postoperative period was uneventful. The wound is drained by a silicone tube connected to a vacuum bag. In the first days after surgery - up to 50 ml of lymph per knock. After removal of the drainage tube on the 6th day, lymphorrhea was not noted. An excellent cosmetic result was obtained. The patient was discharged on the 9th day after surgery. During the control ultrasound examination after 3 months, a thin uniform capsule is determined around the endoprosthesis.

Thus, the claimed method has significant advantages compared with known methods of the same purpose and meets the criteria of patentability.

Claims (1)

The method of breast plastic surgery, including fixing the mesh of biocompatible material to the soft tissues of the mammary gland, characterized in that the breast plastic is performed using an endoprosthesis, the endoprosthesis is placed in a bag from an absorbable vicryl network, which is tightened from above, fixed with interrupted sutures to the surrounding breast tissue while the upper pole is fixed to a functioning pectoralis major muscle.

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