RU2526958C1 - Method for areolar surgical approach to breast tissue and retromammary space - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: arcuate transareolar incision of an areola is performed from above from inside downwards to the outside at an angle of 30° to a horizontal with going around a nipple from below 1 mm from its base.

EFFECT: surgical incision of breast provides better aesthetic effect ensured by the fact that the incision provides wider approach, stays within the areola and passes along areolar tissue relaxation lines.

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Description

The invention relates to medicine, namely to surgery, to methods for quick access to breast tissue and retro-mammary space.

It is well known that the thinnest and most invisible scars after surgery on the mammary gland remain if the incisions were made within the areola. Due to the small thickness and specific structure of the epidermis and smooth muscle layers of the areola, in half of the patients the postoperative scars are generally invisible, while in the rest they represent a subtle thin whitish strip that does not adversely affect the aesthetics of the mammary gland. Any other incisions located outside the areola leave noticeable scars, often significantly worsening the appearance of the mammary gland.

In breast surgery, two methods of operative access located within the areola are most popular: periareolar and transareolar. The first of them was described by Webster in 1946 as a section located between the conditional points corresponding to 3 and 9 hours and bordering the lower areola semicircle (Webster JP Mastectomy for gynecomastia through semicircular intra-areola incision. Ann. Surg., 1946. Vol.124. - P.557).

This access is widespread among domestic and foreign surgeons both in oncological practice and in aesthetic surgery. Through it, it is convenient to remove small benign breast tumors located in the central quadrant and not far from it. With augmenting mammoplasty with silicone implants, this access is considered one of the best.

However, in approximately 60% of the operated patients, a fairly noticeable scar appears on the border of the areola and skin, representing a whitish strip, significantly different in color from both the areola and the surrounding skin.

In the literature, a rare peri-transareolar perithelial section of a W-shape is described (Asian G., Tuncali D., Terzioglu A., Bingul F. Periareolar-transareolar-perithelial incision for the surgical treatment of gynecomastia // Ann. Plast. Surg., 2005. Vol. 54. - P.130-134).

However, the acute angles of the areolar flaps, as a rule, are necrotic due to insufficient blood supply, which subsequently affects the quality of the resulting scar. In addition, a significant section length with three sharp angles deform the areola.

As a prototype, the transareolar incision method described by the Brazilian plastic surgeon Ivo Pitanguy in 1966 (Pitanguy I. Transareolar incision for gynecomastia. Plast. Reconstr. Surg., 1966. Vol. 38, p. 414) was selected. The incision was developed for surgical treatment of gynecomastia, but later it began to be used more widely in both oncology and plastic surgery.

This access is a horizontal diametrical section of the areola through the center of the nipple. A transareolar incision compares favorably with a periareolar incision only when silicone endoprostheses are installed, since vertical dissection of the gland tissue damages the ducts and sinuses to a lesser extent.

But this version of the incision provides a small exposure of tissues and an angle of surgical action than with the use of Webster periareolar access, since the diameter is shorter than the length of the semicircle. In addition, the vertical dissection of the nipple leads to certain difficulties in its recovery and some retraction after healing of the wound.

The aim of the invention is to increase the surgical field and the angle of surgical action compared with the transareolar incision, as well as improving the final aesthetic result during interventions on the mammary gland.

The goal is achieved in that an arcuate transareolar incision is made so that it bypasses the nipple from below 1 mm from its base and is located at an angle of 30 ° to the horizontal (Fig. 1).

This location of the section is dictated by the features of the anatomical transformation of the areola, which eventually takes the form of an ovoid with the largest diameter, located at an angle of about 30 ° to the horizontal and the direction from the top from the inside outwards. In this case, the length of the arcuate incision will be maximum, and the relaxation lines of the areolar tissues optimally correspond to the direction of the incision and allow you to get the maximum aesthetic result.

The method of areolar operative access to breast tissue and the retromammary space is new, since it is not known from the level of medicine in the field of surgery and methods of operative access to breast tissue and the retromammary space.

The novelty of the invention lies in the fact that in order to increase the surgical field and the angle of surgical action compared to the classic direct incision, an arcuate transareolar incision was used for the first time, with a nipple bypassed 1 mm below from its base. When using classical transareolar access, the tissue exposure area is identical to an ellipsoid with the largest diameter equal to the diameter of the areola. The application of the access we have proposed involves an increase in the operating field, since the length of the arc is always greater than the segment connecting its ends. In addition, the use of the proposed method leads to the most achievable aesthetic results in breast surgery - almost imperceptible scar without deformation of the areola. The invention has an inventive step, since for a specialist in the field of plastic surgery and oncology it does not explicitly follow from the level of modern medicine in this field of surgery.

To explain the invention, drawings are provided.

Figure 1 schematically shows the direction of the cut of the left areola (blue line).

Figure 2 shows a preoperative photo of patient N., front view.

Figure 3 shows a postoperative photo of patient N., front view.

Figure 4 shows a preoperative photo of patient K., front view, true right-sided gynecomastia.

Figure 5 shows a postoperative photo of patient K., a view of the sutured wound on the operating table. Below is a removed drug - male breast (mammary) gland.

Figure 6 shows the aesthetic postoperative result of the proposed access, the right areola (black dots are located near the beginning and end of the incision), top view.

Figure 7 - aesthetic postoperative result of the proposed access, the left areola (black dots are located near the beginning and end of the incision), top view.

The method is as follows.

In the position of the patient on the back, under local anesthesia with a 0.25% lidocaine solution with 1: 100000 adrenaline added, arcuate areolar sections are made on both sides with the nipple bypassed 1 mm below its base, at an angle of 30 ° to the horizontal. Areolar flaps are separated from the gland tissue, the latter is removed. The postoperative wound is sutured with an intradermal suture using atraumatic monofilament suture 5/0 with precise adaptation of the wound edges.

We give an example of a specific implementation of the method.

Example 1

Patient N., 21 years old, was admitted to the Department of Reconstructive-Plastic and Aesthetic Surgery, RNII on July 16, 2009 with a diagnosis of

true bilateral gynecomastia.

On examination, enlarged mammary glands were noted within the areola in the form of areolar pseudo hernias (Fig. 2).

On July 17, 2009, under local anesthesia with a 0.25% lidocaine solution with 1: 100000 adrenaline added, arched areolar sections were made on both sides. Areolar flaps are separated from the gland tissue, the latter is removed. A postoperative wound was sutured with an intradermal suture using atraumatic monofilament suture 5/0 with precise adaptation of wound edges.

The postoperative period was uneventful, the sutures were removed on the 8th day.

Primary wound healing. The aesthetic result of the operation is good, the patient is completely satisfied with the appearance of the areola (Fig.3).

Example 2

Patient K., 19 years old, was admitted to the department on 06/08/2012 with a diagnosis of true right-sided gynecomastia.

On examination, an enlarged right breast was noted, with a glandular disk diameter of about 8 cm (Fig. 4).

June 9, 2012, a skin-preserving mastectomy was performed using the proposed access. A view of the sutured areola and the removed preparation of the breast (male mammary) gland is shown in FIG.

Using the proposed method, 26 patients with true gynecomastia were operated on. In all cases, good aesthetic results were obtained, the scars became invisible 3-4 weeks after the operation, and after 3 months they became difficult to distinguish (the right areola - Fig.6, the left areola - Fig.7).

We did not mark out areas of depigmentation of the areola.

The invention “Method of areolar operative access to breast tissue and retro-mammary space” is industrially applicable, as it can be used in healthcare not only in oncology, but also in plastic surgery. For example, for the installation of endomammary silicone implants.

Claims (1)

The method of areolar operative access to breast tissue and the retromammary space, characterized in that an arcuate transareolar incision of the areola is performed from the top from the inside down to the outside at an angle of 30 ° to the horizontal, while the incision bypasses the nipple 1 mm below from its base.

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