RU2562098C1 - Method for breast reconstruction - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: breast is reconstructed. Dimensions of the pre-mounted Becker implant are gradually reduced with replacing simultaneously the breast volume by autologous subcutaneous fat taken from patient's donor areas. A portion of normal saline is evacuated from the implant cavity through a valve, and the prepared autologous subcutaneous fat is introduced along breast tissues. The procedure of breast replacement is repeated up to 5 times every 3 months or less often until the implant is removed when the healthy dimensions are gained.

EFFECT: method enables the less traumatic, staged breast restoration with autologous tissues and the improved aesthetic appearance of the patient.

1 ex, 6 dwg

Description

The present invention relates to medicine, namely to plastic surgery, and can be used in reconstructive surgery of the mammary gland with its own tissues, in particular, after removal of malignant tumors of the mammary gland and previously performed reconstruction of the mammary gland with an implant.

If it is necessary to reconstruct the mammary gland using our own tissues, we apply the movement of skin-fat flaps from the abdomen in various modifications (TRAM, DIEAP) (1, 2). In this type of reconstruction, own tissues from the abdomen are moved to the site of the removed mammary gland on the muscle or vascular pedicle.

Closest to the proposed is a method of breast reconstruction with own fatty tissue (lipofilling) using the BRAVA system (external vacuum tissue expansion). This method was proposed by R. Khouri et al. (3) as an alternative to breast implants in 2012. When it is performed, before and after lipofilling, a special system is used on the reconstructed mammary gland, which provides a moderate vacuum for stretching the skin of the mammary gland and better engraftment of the displaced fatty tissue.

However, known technologies have significant drawbacks, so when moving skin-fat flaps from the abdomen, a rather traumatic surgical intervention is performed. There are frequent cases of specific postoperative complications (partial or complete necrosis of the flap, hernial protrusion in the area of the flap fence, etc.). When using the BRAVA system, there are inconveniences when masking the vacuum system with outer clothing and complications may occur in the form of pressure sores at its base. In addition, the BRAVA system is not certified in Russia.

The use of these methods is limited in patients with previous reconstruction of the mammary gland by Becker expanders-prostheses (hereinafter the Becker implant), since it negates the entire result of the previous reconstruction.

Based on the existing level of technologies for breast reconstruction and elimination of the disadvantages of the known methods, the task was set: to restore the cosmetic appearance and volume of the mammary gland after its removal and patient’s dissatisfaction with the Becker implant due to internal stretching of the mammary gland and replacement of the artificial implant are less traumatic own tissues.

The problem is solved as follows.

Reconstruction of the mammary gland includes restoration of the volume of the mammary gland with its own fatty tissue and stretching of the tissues in place of the formed mammary gland. New in solving this problem is that the volume of a previously installed Becker implant is gradually reduced with the simultaneous replacement of the volume of the mammary gland with its own fatty fiber, harvested from the patient’s donor zones. At the same time, through the valve in the Becker implant, part of the volume of saline solution is evacuated from its cavity with which the Becker implant is filled and the prepared fatty tissue is introduced along the contour of the mammary gland tissues. Then, compression garments are put on donor sites for fatty tissue for 3 weeks. The course of replacing the volume of the mammary gland is repeated up to 5 times with an interval between courses of at least 3 months and continues until the physiological saline is completely removed from the internal cavity of the Becker implant, the Becker implant is removed and the internal volume of the mammary gland is replaced with its own fatty tissue until a healthy breast is reached.

We explain the essential distinguishing features of the proposed "Method of breast reconstruction."

The gradual decrease in the volume of the previously installed Becker implant with the simultaneous replacement of the volume of the mammary gland with its own fatty tissue, prepared from the patient’s donor zones, allows using the result of the previous reconstruction with the existing internal expansion of the mammary gland tissues, and gradually replacing the artificial tissues with their own. The results obtained are more natural than when using artificial implants. The proposed method is less traumatic in comparison with reconstructions of the mammary gland with skin-fat flaps from the abdomen.

Performing replacement of the volume of the mammary gland with staged courses, which are repeated up to 5 times with an interval between courses of at least 3 months, and continuing treatment until the physiological saline is completely removed from the internal cavity of the Becker implant, the Becker implant is removed and the internal volume of the breast is replaced with its own fatty tissue until achieving the size of a healthy mammary gland allows creating conditions for the engraftment of transferred fatty tissue and the reconstruction of a sufficient amount of mammary gland.

Wearing compression underwear at the donor sites for fatty tissue intake for 3 weeks is necessary for faster healing and prevention of bumps in the donor area.

Distinctive techniques of the proposed method are that after a standard breast reconstruction with Becker implant and patient dissatisfaction with the result, the existing internal tissue stretching is used to gradually replace artificial tissues with their own fatty tissue. In a less traumatic way, using the results of the previous reconstruction, it is possible to obtain more natural results of breast reconstruction.

The patent research on subclasses А61В 17/00 and the analysis of scientific and medical information reflecting the current level of operational methods for breast reconstruction did not reveal identical technologies.

A comparative analysis of the proposed method and known technologies shows that the proposed method differs in the above methods from known technologies. In this connection, we can conclude that the claimed technical solution meets the criteria of the invention of "novelty."

The technical result of the proposed method is to increase the effectiveness of the treatment of patients with breast reconstruction using Becker implants.

According to the Irkutsk Regional Oncology Center over the past three years (2011, 2012, 2013), 68 Becker implants were installed to reconstruct the mammary gland after its removal. Three quarters of patients are not satisfied with the result of breast reconstruction with a Becker implant.

From the analysis of patent and specialized literature, the authors found that the proposed technical solution has features that distinguish it not only from the prototype, but also from other technical solutions in this field of medicine. We have not found a method for reconstructing the mammary gland using internal stretching of the mammary gland.

In addition, based on the analysis of clinical material, the authors of the proposed method revealed the following advantages:

A less traumatic restoration of the appearance and volume of the mammary gland after its removal in case of patient dissatisfaction with the result obtained from reconstruction with a Becker implant due to internal stretching of the mammary gland and replacement of the artificial implant with its own tissues.

The interconnection and interaction of the essential distinguishing features of the proposed method ensures the achievement of a new technological medical result in solving the problem, namely: maximally reproduce the cosmetic appearance of the mammary gland of patients after its removal due to malignant formation of the mammary gland. From the above it follows that the claimed method meets the criterion of "inventive step".

The proposed method for reconstructing the mammary gland with its own tissues can be successfully applied in practical public health when restoring the mammary gland after treatment of cancer, removing the mammary gland and reconstructing with a Becker implant that does not satisfy patients. The proposed method meets the criteria of the invention of "industrial applicability".

The essence of the proposed method is illustrated by illustrations, which show the stages of the reconstruction of the mammary gland of patient O .:

FIG. 1 - the appearance of patient O. after removal of the left breast

FIG. 2 - the result of reconstruction of the left mammary gland with a rotational thoracodorsal flap and a Becker implant;

FIG. 3 - the result of the first stage of reconstruction of the left breast with own fatty tissue by lipofilling (injection of fatty tissue) after a partial decrease in the volume of the Becker implant;

FIG. 4 - the second stage of the introduction of fatty tissue (lipofilling) after the next deflation (volume reduction) of the Becker implant;

FIG. 5 - the result of the third stage of breast reconstruction after removal of the Becker implant;

FIG. 6 - the appearance of patient O. after vertical reduction mammoplasty on the right.

The essence of the proposed "Method of breast reconstruction" is as follows.

Preliminarily, according to the Coleman method (4), fatty tissue is harvested in places of excessive accumulation of fiber (e.g., flanks and lower abdomen), which, after appropriate preparation and partial reduction of the Becker implant volume, is introduced through the valve along the contours of the reconstructed mammary gland. Wearing compression underwear at the donor sites for fatty tissue intake for 3 weeks is necessary for faster healing and prevention of bumps in the donor area.

Repeated stages of reconstruction are carried out no earlier than 3 months. At least 5 courses are required to ultimately remove the Becker implant completely and replace its volume only with its own adipose tissue, which forms the reconstituted mammary gland.

We explain the essence of the proposed "Method of breast reconstruction" with a clinical example:

Patient O., born in 1957, was first admitted to the clinic of FSBI NTSRVH SB RAMS 02/13/2012 with complaints of the absence of the left breast. A mastectomy was performed in 2001 at the Regional Oncology Dispensary in Irkutsk for cancer of the left breast, 2A st., T2N0M0. A course of polychemotherapy in 2001

On examination, it was revealed that the left mammary gland is absent. Good quality crescent-shaped postoperative scar. There are no signs of relapse of cancer. The right mammary gland without features (see Fig. 1). The operation was performed on February 13, 2012 - delayed plastic surgery of the left mammary gland with a rotational thoracodorsal flap and installation of a Becker implant (Mentor SN 6483969-003), gel volume - 110 ml, volume for filling with physiological saline - 215 ml. 55 ml of physiological saline was administered once during the operation. The Becker implant valve is located in the anterior axillary line. After the operation, the volume of physiological solution is introduced completely in stages (see Fig. 2).

The patient was not satisfied with the result of reconstruction of the left breast. The features of the reconstruction of the gland with a Becker implant showed up - the displacement of the implant upward, asymmetry in relation to a healthy right mammary gland.

The patient was offered the option of reconstructing the mammary gland by gradually filling the volume of the mammary gland with its own fatty tissue using internal stretching and subsequent removal of the Becker implant.

The first course of staged reconstruction of the left breast by lipofilling was carried out on 08.24.2012. Preliminarily, according to the Coleman method (4), fatty fiber was prepared from the fiber of the flanks and lower abdomen, which, after appropriate preparation and partial reduction of the volume of the Becker implant, was inserted through the 180 ml valve along the contours of the formed left breast and into the tissue of the thoracodorsal flap with a total volume of 255 ml . The result of the operation is satisfactory (see Fig. 3).

The second stage of the staged reconstruction of the left breast was performed on December 21, 2012. Fatty tissue was obtained from the same donor areas of the patient and after appropriate preparation according to the Coleman method (4) and a decrease in the volume of the Becker implant by 40 ml was introduced along the contour of the formed left breast and into the tissue of the thoracodorsal flap, the volume was 318 ml. The result of the second stage of the operation is satisfactory (see Fig. 4).

The third stage of the reconstruction was carried out 05/31/2013. Fatty tissue was taken from the breeches and upper-inner thighs of the patient. Complete removal of the Becker implant from the old scar after mastectomy and the implant valve from a separate incision was performed. Then, the prepared fatty tissue with a volume of 360 ml was introduced into the tissue of the thoracodorsal flap along the contour of the formed left mammary gland and into the tissue of the thoracodorsal flap. The reconstruction of the left mammary gland is completed, the mammary gland consists only of its own tissues (see Fig. 5).

Vertical reduction mammoplasty of the right breast was performed on 11/14/2013 (see Fig. 6). The reconstruction of the nipple-areolar complex is planned to be completed in the near future.

The patient was examined 1 and 3 months after completion of reconstruction of the left breast. The mammary glands are without features. Soft, mobile, symmetrical. Tumor formations are not determined. The patient is satisfied with the result.

Thus, the proposed “Method for breast reconstruction” with own fatty tissue using internal stretching, in comparison with known technologies, allows less traumatic, phased replacement of artificial tissues (implants) originally used for breast reconstruction with own fatty tissue, thereby improving aesthetic the appearance and volume of the mammary gland.

Information sources

1. Grotting J.C., Urist M.M., Maddox W.A. Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction. Plast. Reconstr. Surg. 83 (5): 828-841, May 1989.

2. Blondeel F.N., Morrison C.V. Deep inferior epigastric artery perforator flap. In Perforator Flap Anatomy, Technique, & Clinical Application. Ed. F.N. Blondeel et al. St. Lous: QMP, 2006 - P. 386-403.

3. Khouri R.K., Eisenmann-Klein M., Cardoso E., Cooley B.C., Kacher D., Gombos E., Baker T.J. Brava and autologous fat transfer is a safe and effective breast augmentation alternative: results of a 6-year, 81-patient, prospective multicenter study. Plast Reconstr Surg 2012; May; 129 (5): 1173-1187.

4. Coleman S.R., Saboeiro A.P. Fat grafting to the breast revisited: safety and efficacy. Plast. Reconstr. Surg. 2007; March: 775-785.

Claims (1)

A method for reconstructing the mammary gland, including restoring the volume of the mammary gland with its own fatty tissue and stretching the tissues in place of the formed mammary gland, characterized in that the volume of the previously installed Becker implant is gradually reduced while replacing the volume of the mammary gland with its own fatty tissue obtained from the patient’s donor zones, this through the valve in the Becker implant from his cavity is evacuated part of the volume of physiological solution with which the Becker implant is filled, and fatty fiber prepared and prepared according to the Coleman method is introduced along the breast tissue, then compression linen is put on donor sites for fatty tissue for 3 weeks, the replacement course of the volume of the mammary gland is repeated up to 5 times with an interval between courses of at least 3 months and continues until complete excretion of physiological saline from the internal cavity of the Becker implant, removal of the Becker implant and replacement of the internal volume of the mammary gland with its own fatty tissue until p zmerov healthy breast.

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