RU2588487C1 - Method for performing surgical operations for gynecomastia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, specifically to surgery. Method includes applying on breast area of patient's skin marking with application of vertical middle associated attached line and para-areolar ring formed by inner circular line within areola and concentric external circular line. De-epidermisation is carried out within para-areolar ring. Surgical approach is performed by resection of skin and excessive fat. Method includes removing through surgical approach hypertrophied breast gland and excessive fat tissue with subsequent execution of hemostasis. Wounds are closed. At breast area is additionally applied to make angular pattern line from nipple to jugular notching sternum and from nipple to middle of clavicle. Method includes applying a marking angle, for which in direction from nipple is perpendicular to front axillary breast line and from point of their intersection is lateral line on both sides of perpendicular to outer circular line so as to cover from 1/3 to 1/2 of its circle with vertex angle in said point of intersection, so that angle formed by para-areoral together with ring form a pattern in form of an isosceles triangle with concave base. Surgical approach is made along boundaries of this triangle, with subsequent execution of hemostasis; through said access is liposuction excessive fat.

EFFECT: method allows removing excessive fat deposition in lateral areas of chest, preventing deformation of nipple in postoperative period.

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Description

The invention relates to the field of surgery, specifically to perform surgical operations to correct the shape of the breast.

A known method of performing a surgical operation to eliminate gynecomastia, including applying to the chest region of a patient in a standing position a skin marking with a vertical mid-sternal line and a paraareolar ring formed by an internal circular line within the areola and a concentric external circular line; epidermalization in the area of the paraareolar ring; performing surgical access by resection of the skin and excess fat; removal through surgical access of hypertrophied mammary glands and excess adipose tissue with subsequent hemostasis; Wound closure: The Para-Areolar Donut De-Epithelialization: A Useful Approach for Grade III Gynecomastia / Egypt, J. Plast. Reconstr. Surg., Vol. 36, No. 1, pp. 87-90. Jan. 2012.

The specified method is an analogue and prototype of the invention. The known method has several significant disadvantages. Due to the limited surgical access, the surgeon has to work blindly when the breast is excised, hemostasis is difficult (especially in the peripheral parts of the surgical wound), there is large blood loss, it is impossible to remove excess fatty tissue in the lateral areas of the chest wall. Due to the large difference between the length of the outer and inner borders of the epidermalization zone, the formation of pronounced longitudinal skin folds-rays coming from the areola occurs. Pronounced lateral tension of the skin leads to deformation of the areola of the nipple in the late postoperative period, as well as to the formation of a wide scar. Inherent in the prototype method, the disadvantages are exacerbated with an increase in the size of gynecomastia.

The present invention is aimed at eliminating the disadvantages inherent in the prototype method, that is, it solves the technical problem of increasing the efficiency of the surgical operation to eliminate gynecomastia.

The stated technical problem is solved in that in the method of performing a surgical operation to eliminate gynecomastia, including applying to the patient’s chest area in a standing position a skin marking with a vertical mid-sternal line and a paraareolar ring formed by an inner circular line within the areola and a concentric external circular line; epidermalization in the area of the paraareolar ring; performing surgical access by resection of the skin and excess fat; removal through surgical access of hypertrophied mammary glands and excess adipose tissue with subsequent hemostasis; suturing the wound, according to the invention, additionally forming the angular pattern of the line from the nipple to the jugular notch of the sternum and from the nipple to the middle of the clavicle; marking angle is applied, for which, in the direction from the nipple, draw a perpendicular to the anterior axillary line of the chest and from the point of intersection draw side lines on both sides of the perpendicular to the outer circular line so as to cover from 1/3 to 1/2 of its circumference, with the apex of the angle at the point of intersection, so that this angle, together with the paraareolar ring, forms a pattern in the form of an isosceles triangle with a concave base; surgical access is performed along the boundaries of this triangle, followed by hemostasis; while through this access carry out liposuction of excess fatty tissue.

A technical result is expected from the implementation of the invention, consisting in increasing the efficiency of a surgical operation to eliminate gynecomastia.

The invention is illustrated in FIG. 1-5:

- FIG. 1 represents a patient with skin markings applied to the body, before surgery to eliminate bilateral gynecomastia;

- FIG. 2 represents the left breast after surgery through angular access;

- FIG. 3 represents the left breast after a purse string suture around the nipple-areolar complex;

- FIG. 4 represents the left breast after suturing a wound;

- FIG. 5 represents the patient a month and a half after the operation to eliminate bilateral gynecomastia.

The surgical operation to eliminate gynecomastia according to the invention is performed in the following sequence.

Before direct surgery, on the patient’s thoracic region, when he is standing, apply (washed off subsequently) skin markings: see FIG. 1. It includes a vertical mid-sternal line, to the right or / and to the left of which, according to the specific type of gynecomastia (right-, left-, bilateral), a number of other lines are applied. Draw the lines forming the angular pattern from the nipple to the jugular notch of the sternum and from the nipple to the middle of the clavicle. The nipple is surrounded by a circular line within the areola (along the border or inside to reduce the areola) and a concentric external line, usually at a distance of 10-12 cm from the mid-sternum. In the direction from the nipple, a perpendicular is drawn to the anterior axillary line of the chest (visual reference), and lateral lines are drawn from the intersection point on either side of the perpendicular to the outer circular line so as to cover from 1/3 to 1/2 of its circumference. The result is a figure in the form of an isosceles triangle with a concave base.

Performed skin marking outlined areas of the upcoming physical surgical impact on the tissue. It is carried out with general anesthesia of the patient, in a supine position.

With bilateral gynecomastia, one breast is operated on, then at a certain stage (as shown below) they switch to the second. First, epidermization of the annular paraareolar region of the chest between two circular lines is carried out. Then, a lipectomy is performed with the formation - along the borders of the applied triangle - of an open angular access to the mammary gland. Carry out hemostasis. Through the formed access, the hypertrophied mammary gland is removed, leaving the areola of the nipple and retaining the nourishing fascia. Perform additional liposuction of excess fatty tissue in order to form a smooth contour of the pectoral region (FIG. 2). Carry out hemostasis.

Then proceed to the operation of the second breast, repeating for her the operations described above.

Corner patterns on the skin, formed by lines from the nipple to the jugular notch of the sternum and to the middle of the clavicle, serve as visual guidelines for correcting the height of the nipple, as well as to achieve symmetry of the left and right pectoral areas. Upon reaching this symmetry, suturing of wounds is started. First, a skin suture is performed, tightening the tissue in the area between the extreme points of the open angular wound, which reduces the outer circumferential line of the skin marking by about half. Then, a purse string suture is performed along it, narrowing the skin tissue around the nipple-areolar complex to form the normal diameter of the male areola (FIG. 3).

Next, separate nodal sutures are placed on the subcutaneous fatty tissue, the intradermal suture on the lateral incision, individual nodal sutures on the areola of the nipples: see FIG. 4. Leave drainage in the subcutaneous fat.

The day after surgery, they perform ligation and drainage.

An example implementation of the method according to the invention.

Patient S., 20 years old, who was in the adult surgical department of the clinic, was diagnosed with bilateral mixed gynecomastia, breast ptosis. A surgery to correct the shape of the breast is planned.

Before surgery, skin markings were applied to the patient’s chest area while standing. We drew a vertical mid-sternal line, to the right and left of it performed symmetrical patterns on both sides of the chest. Draw a line from the nipple to the jugular notch of the sternum and from the nipple to the middle of the clavicle. Two concentric lines were drawn around the nipple: the inner line within the areola, with a 2 mm indent from its border and the outer one with a 11 cm indent from the mid-sternum line. In the direction from the nipple, a perpendicular was drawn to the anterior axillary line of the chest, from the intersection point, lateral lines were drawn along the sides of the perpendicular to the outer circular line with 1/3 of its circumference. The result was a figure in the form of an isosceles triangle with a concave base.

After applying the skin marking, the general anesthesia of the patient was performed and surgical operation was started. It started from the left chest. Initially, epidermization of the annular paraareolar region between two circular lines was carried out. A lipectomy was performed, with the formation - along the borders of the applied triangle - of open angular access to the mammary gland. We carried out, using bipolar forceps, hemostasis. Through the formed access, the hypertrophied mammary gland (approximately 10 cm in diameter) was removed, leaving the areola of the nipple and preserving the nourishing fascia. An additional liposuction of excess fatty tissue was performed in order to form a smooth contour of the pectoral region. We carried out, using bipolar forceps, hemostasis.

Then, the above operations were performed on the patient's right chest. Upon reaching symmetry of the left and right pectoral areas, suturing of wounds was started. First, a polyester 2/0 skin suture was sutured, tightening the tissue in the area between the extreme points of the open angular wound, then a polyester 2/0 suture suture was sutured, narrowing the skin tissue around the nipple-areola complex to form the normal diameter of the male areola. Next, separate nodal sutures (Vicryl 3/0 thread) were placed on the subcutaneous fat, an intradermal suture (5/0 monocryl) on the side incision, and separate nodal sutures on the areola of the nipples (4/0 prolene). Drainage was left in the subcutaneous fat.

The day after surgery, they performed ligation and removed the drains. Blood supply to the nipple-areolar complex was normal. Signs of ischemia of the areola of the nipples were not observed.

The wound healing process lasted 20 days, after which the skin sutures were removed. However, undesirable postoperative changes were not observed.

Comparison of photographs of the patient before the operation (FIG. 1) and a month and a half after it (FIG. 5) confirmed the predicted aesthetic effect of the performed surgical operation. The visual impression coincided with the patient’s high self-esteem.

Thus, experimental practice has proved the effectiveness of the proposed method, the expected technical result from the invention, which consists in increasing the efficiency of a surgical operation to eliminate gynecomastia, is confirmed. The invention is especially relevant in the case of gynecomastia of large volumes with ptosis of the breast.

Claims (1)

A method for performing a surgical operation to eliminate gynecomastia, including applying a skin marking on the patient’s chest area with a vertical mid-sternal line and a paraareolar ring formed by an internal circular line within the areola and a concentric external circular line; epidermalization in the area of the paraareolar ring; performing surgical access by resection of the skin and excess fat; removal through surgical access of hypertrophied mammary glands and excess adipose tissue with subsequent hemostasis; suturing the wound, characterized in that the line forming from the nipple to the jugular notch of the sternum and from the nipple to the middle of the clavicle is additionally applied to the thoracic region; marking angle is applied, for which, in the direction from the nipple, draw a perpendicular to the anterior axillary line of the chest and from the point of intersection draw side lines on both sides of the perpendicular to the outer circular line so as to cover from 1/3 to 1/2 of its circumference, with the apex of the angle at the point of intersection, so that this angle, together with the paraareolar ring, forms a pattern in the form of an isosceles triangle with a concave base; surgical access is performed along the boundaries of this triangle, followed by hemostasis; while through this access carry out liposuction of excess fatty tissue.

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