RU2631869C1 - Method for mammoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: skin is cut along the areola. Penetration is performed through the incision into the retromammary space, a cavity for the implant is formed and drained. The implant is placed into the cavity, fibrin glue is injected into the cavity. The MG is brought to the given shape, fixed and sutured, the incision is glued. At that, 12-14 days prior to the operation, the MG surface is divided into squares with side length of ~ 2.0 cm and a mesh is applied. At the center of each square, botox is injected at a rate of 2.0-2.5 units per square. Also, botox is injected in the large pectoral muscle at a rate of 20-30 units per muscle. In addition, during the operation, prior to implant insertion into the cavity, botox injection is repeated at a rate of 20-30 units per muscle in the base and along the fibers of the large pectoral muscle. Fibrin glue is used in a mixture with a solution of a nonpolarizing muscle relaxant, and the cavity is washed with an antibiotic solution before drying.

EFFECT: method has a high aesthetic effect, ensures the stability of the mammary gland with the necessary shape, excludes scars on the incision site, allows to significantly reduce postoperative rehabilitation and minimize or avoid postoperative pain sensations, local inflammatory processes and discomfort.

3 cl, 19 dwg, 3 tbl, 3 ex

Description

The invention relates to aesthetic medicine, and more specifically to plastic surgery, and is intended to correct the shape of the mammary gland.

There is a method of breast enlargement, in which the cavity is formed endoscopically in the retro-mammary space and gradually filled with a biologically inactive filler [1].

This method, firstly, does not provide a certain shape to the breast, and secondly, the use of a filler, which is a non-shell implant, introduces a high risk of traumatic deformity of the breast and, in addition, the use of such a filler is temporary.

In plastic reconstructive surgery, a method of augmentation mastoplasty is also known, in which the boundaries of the breast endoprosthesis bed are determined by marking anatomical formations, the mammary plexia points are noted, mastopexy is performed by sequential fixation of the breast’s own fascia with the fascia of the chest muscle at specified points and then set into the formed bed of the retromammary space endoprosthesis [2].

The disadvantage of this method is the presence of postoperative scars, which reduces the cosmetic effect, and, in addition, a high risk of endoprosthesis displacement and, consequently, breast deformation.

Closest to the claimed invention in its technical essence and the achieved technical result is a method of breast plastic surgery, including incision of the skin along the areola, penetration through the incision into the retromammar space, the formation of a cavity under the implant by spreading tissue layers, draining the cavity, introducing fibrin glue into it, followed by into the cavity of the implant, giving the MF the desired shape, fixing it, and suturing, and gluing the incision [3].

The specified prototype represents a fundamental solution to the problem within the scope of the task posed and implemented in this invention, namely, “designing” and maintaining the shape of the designed MF. At the same time, it is known that the human body, in particular such a delicate formation as the mammary gland, in our case, considered not from a biofunctional, but an aesthetic point of view, in reality is quite diverse in topographic and geometric parameters. Therefore, with micromastia of breast plastic according to the specified prototype, it is very difficult and practically impossible to achieve the formation and preservation of the desired shape of the breast, since the skin of the operated breast is clearly not enough to completely and freely cover the increased volume of the breast.

In addition, another disadvantage of this prototype (as well as other methods of breast plastic surgery involving surgical intervention) is the long-term postoperative rehabilitation (hospitalization or outpatient monitoring), the long-term discomfort caused by pain, local inflammatory processes, etc. P. phenomena.

The technical result, the achievement of which the creation of this invention is directed, is to achieve a high and long-lasting cosmetic effect by giving the mammary gland a stable aesthetically sustained shape, eliminating the appearance of a scar at the incision site, and also reducing the time of postoperative rehabilitation (hospitalization or outpatient monitoring) and minimization or exclusion of postoperative pain and local inflammatory processes.

The technical result is achieved by the fact that with micromastia, the skin is incised along the areola, penetrated through the incision into the retromammary space, the cavity is formed under the implant, the cavity is drained, the implant is inserted into the cavity, fibrin glue is introduced into the cavity, the MF is given the desired shape, and it is fixed, and suturing and gluing the incision, while 12-14 days before the operation, the MF surface is marked into squares with a side length of ~ 2.0 cm and a mesh is applied, an injection of shoes is carried out in the center of each square Ca in the skin at the rate of 2.0-2.5 units. per square, also an injection of Botox is carried out in the pectoralis major muscle at the rate of 20-30 units. on the muscle, in addition, during the operation, before placing the implant in the formed cavity, Botox is injected again at the rate of 20-30 units. on the muscle in the base and along the fibers of the pectoralis major muscle, fibrin glue is used in a mixture with a solution of an underpolarizing muscle relaxant, and the cavity is washed with an antibiotic solution before drying, while peripheral muscle relaxants are used as an underpolarizing muscle relaxant and aminoglycoside antibiotics are used as an antibiotic.

The difficulty of giving a new form of MF is that the performer is dealing with living flesh, and the latter has extreme and inconsistent form change. Moreover, a change in shape over time is irreversible. The task of the contractor, therefore, is to ensure that the actions of the new formation of the breast ensure not only the correct fulfillment of the patient’s wishes (in the shape and size of the breast), but also to inform the stability, the invariability of the shape for the long term. In addition, it is necessary to achieve the maximum cosmetic effect - if not completely eliminated, then minimize the appearance of a scar at the site of the areola incision.

In breast plastic surgery with a sheath implant, it seems most appropriate to access the retro-mammary or retro-muscular region transareally (or transaxillary). This is dictated by the circumstances that in this way a minimal violation of the integrity of the skin of the breast, including a submammary fold, is achieved.

In the case of enlargement of the breast, in the case of micromastia, the volume (depending on the desired size of the breast) may increase by 2-3 times, and the surface area of the breast is ~ 2 times. The epidermis, dermis and hypodermis have elasticity along with, of course, high relaxation ability under mechanical stretching, however, these skin properties have their limits in quantitative terms and significantly depend on many factors - the patient's age, general condition of the body, etc. Therefore, for the successful operation to increase MF with micromastia, it seems necessary to draw on a technique to increase skin elasticity. This is achieved by injecting Botox into the skin of the breast, and this injection is performed 12-14 days before surgery.

The most important factor in the “formation” of the MF of the desired esthetically sustained form with micromastia is the stretchability of the skin in the area of the lower slope of the chest, therefore, Botox injection is carried out to a greater extent in this area.

As the implant, silicone shell implants are used, for example, Mentor, Natrelle, etc.

As a suture material, absorbable sutures are used, for example, Vikril, Polysorb and other surgical sutures similar in functional characteristics.

For example, Tissucol Kit et al. Are used as fibrin glue, however, it is most preferable to use fibrin glue from the patient’s own (autologous) blood, since in this case the biochemical processes in the cavity during implantation will be accompanied with a minimum of complications.

As strips, a surgical patch is used, for example, Steri-Strip, etc.

As Botox, for example, Relatox (botulinum toxin type A in combination with hemagglutinin), Xeomine, Lantox and other Botox analogues are used.

Long-acting peripheral muscle relaxants, such as arduan, melliktin, diplacin, are used as a non-polarizing muscle relaxant.

Aminoglycoside antibiotics, such as gentamicin, monomycin, neomycin and other similar antibiotics, are used as an antibiotic to flush the cavity under the implant.

Body temperature is monitored by mercury maximum or digital (with memory) thermometers. The body temperature of the near-surgical area is monitored, for example, with a Medisana FTN IR thermometer or a FLUKE 570 series pyrometer.

The biomechanical characteristics of the skin (elasticity and relaxation) are monitored by Cutometer 580 MPA (the active element is the Reviscometer RV600 sensor).

ESR monitoring is carried out by the ESR meter PR-3.

The remaining materials necessary and used in the implementation of the claimed technical solution, techniques and quantitative characteristics of the substances used in the implementation of this method will be mentioned in detail and described in the examples of specific implementation of the invention.

The invention can be implemented as follows.

Initially, 12-14 days before the operation, the MF surface is marked into squares with a side length of ~ 2.0 cm and a grid is applied, in the center of each square Botox is injected into the skin at the rate of 2.0-2.5 units. per square, also an injection of Botox is carried out in the pectoralis major muscle at the rate of 20-30 units. on the muscle, in addition, during the operation, before placing the implant in the formed cavity in the base of the pectoralis major muscle, Botox is injected. Next, a skin incision is made along the lower half of the areola circumference, without going beyond its borders, they penetrate through the incision into the retromammary space and with a blunt surgical instrument (for example scissors) form a cavity under the implant, for example, “pushing” the space between the pectoral muscles. Then the cavity is washed with an antibiotic solution, dried, an implant is placed in it and fibrin glue (possibly autologous) is introduced in a mixture with a solution of an underpolarizing muscle relaxant, hands give the MF a predetermined shape and hold in this state for at least 2 ÷ 3 minutes until the glue has completely set. (in this case, the adhesive distributes the adhesive evenly over the walls of the cavity). Next, a deep dermal suture with absorbable suture is performed on the incision, with a stitch length within 5–8 mm, and the upper layer of the epidermis is spread apart and the resulting gap is filled with fibrin glue (without muscle relaxant), the edges of the gap are joined end-to-end and fixed with a strip followed by dry dressings.

Note 1: Biomechanical characteristics of the skin of the breast (elasticity and relaxation) are determined before Botox injection, i.e. 12-14 days before surgery; when marking the surgical field before surgery and after removing the dry dressing after surgery.

Note 2: For ethical and technical reasons, the invention is carried out by volunteers after consultation with the ethics committee.

For a better understanding, the invention can be illustrated, but not exhausted, by the following examples of its specific implementation.

Example 1

Patient A ***, 31 years old, volunteer. I agreed to the proposal to increase the volume of breast (see Photo 1). Preoperative marking is shown in Photo 2.

Characteristics of the breast skin: thin, elasticity is reduced, striae are practically absent, breast size <A, areola diameter 5.0 cm, ptosis is absent, there is a slight asymmetry of the nipple-areolar complex (SAK).

Initially, 14 days before surgery, the patient is injected with Botox in the pectoralis major muscle (Relatox at the rate of 25 units per muscle). The surgical field - the MF surface is marked into squares with a side length of 2.0 cm by applying a grid and Botox is injected into the skin in the center of each square (at the rate of 2.0-2.5 units per square). In FIG. 1 shows the topography of the injection of Botox into the skin of the breast, where asterisks indicate injection points as an example. The operation is performed under general anesthesia. During the operation, the Botox injection is carried out initially at the base of the pectoralis major muscle and along its fibers (Relatox at the rate of 25 muscle). Further along the outer lower border of the areola, a skin incision is performed. Cut length 5.5 cm; blunt scissors form a cavity under the implant "pushing" the space between the pectoral and small muscles - form a pocket 11.5 wide and 12.0 cm high. Then the cavity is washed with an antibiotic solution (monomycin, at the rate of 1 mg per 50 ml of physiological saline 0.9 % sodium chloride), dry the pocket cavity with sterile wipes, place an implant in it (Natrelle FM, 270 ml, profile 5.5 cm, width 11.5 cm, height 12.0 cm), Tissucol Kit fibrin glue is injected (injected) into mixtures with an underpolarizing muscle relaxant - mellictin (10 g of glue + 0.2 g of muscle relaxant NTA), MF arms impart a predetermined shape and held in this condition 2.5 minute to complete curing adhesive (the adhesive is distributed uniformly along the walls of cavity pocket smoothing). Next, the incision on the areola is sutured with a deep dermal suture with an absorbable thread (Vicril 4-0), the stitch length is 5.5 mm. Then the upper layer of the epidermis in the incision is pushed apart and the resulting gap is filled with glue without muscle relaxant, butt edges are joined end-to-end and fixed with a Steri-Strip strip. End the operation by applying a dry dressing.

The postoperative condition of the patient is monitored by the following parameters: control of body temperature and the near-surgical area (maximum 1/10 ° С mercury thermometer and FLUKE 570 series pyrometer, respectively); ESR monitoring - ESR meter PR-3; In FIG. Figures 2 and 3 show the dynamics of changes in the biomechanical characteristics of the skin of the breast (elasticity - deformation or elongation along the ordinate in Fig. 2 and relaxation in seconds along the abscissa in Fig. 3) 14 days before the operation, during the operation and after removal of dry bandages after surgery - positions I, II and III, respectively, on each figure.

The postoperative condition of the patient (control of body temperature and area of operation and ESR) is presented in Table 1.

According to the patient's condition, the dry dressing is removed on the 10th day after the operation.

Photos 3 and 4 show the postoperative condition of the patient’s breast after 2 and 4 months - complete healing in the areas of cuts, scars and scars are absent, the degree of correction is complete with a pronounced cosmetic effect. The length of the lower slope of the breast is determined by measuring a medical tape measure from the lower base of the nipple to the submammary fold. The change in the shape of the lower slope of the breast after surgery is clearly visible in Photos 3 and 4.

The rehabilitation period after the operation took 5 days - 1 day in the hospital and 4 days outpatient monitoring (the patient was in the hospital without restricting activities). Compression underwear was used within 10 days after surgery. The rehabilitation period was practically not accompanied by pain and swelling.

Example 2

Patient B ***, 21 years old. Agreed to increase breast. MF condition before surgery (see Photo 5): Characteristics of the breast skin: thick, no striae, low elasticity, long-lasting relaxation, breast size A, diameter of the areola 4.8 cm, slight asymmetry. The marking of the surgical field is shown in Photo 6.

The operation is carried out as in Example 1, except that autologous fibrin glue mixed with diplacin (12 g of glue + 0.3 g of muscle relaxant) is injected into the cavity of the pocket - 200 ml of blood is taken from the patient a day before surgery and prepared from it fibrin glue “mini-laboratory CRYOSIL FS”). Botox injection is carried out 12 days before the operation, the implant is Natrelle FM, 275 ml, profile 6.5 cm, width 11.5 cm, height 12.0 cm.

The postoperative condition of the patient (control of body temperature and the area of operation and ESR) is presented in Table 2.

In FIG. Figures 4 and 5 show the dynamics of biomechanical characteristics of the skin of the breast (elasticity and relaxation) - before (I), before (II) and after surgery (III), i.e. 12 days before surgery before Botox injection, on the day of surgery and 5 days after surgery).

According to the patient's condition, the dry dressing is removed on the 6th day after the operation.

The rehabilitation period after the operation took 4 days - 1 day in the hospital and 3 days outpatient monitoring (the patient was in the hospital without restricting activities). Compression underwear was used within 10 days after surgery. The rehabilitation period was practically not accompanied by pain and swelling.

The postoperative condition of the patient’s MF after 2 and 4 months is shown in Photo 7 (the topographic parameters of the operated MF are shown in this photo) and 8, respectively: there is complete healing in the incision areas, scars and scars, the degree of correction is complete with a pronounced cosmetic and aesthetic effect.

Example 3

Patient B ***, 34 years old. Volunteer agreed to breast augmentation surgery. Characteristics of the breast skin: thin, no striae, elasticity reduced, breast size <A, areola diameter 4.5 cm, asymmetry is present (see Photo 9). The marking of the surgical field and the topographic parameters of the breast are presented in Photo 10.

The operation is carried out as in Example 1, except that the physical parameters of the incision (3.5 cm), the formed pocket (cavity width 10 cm and height 11.0 cm) are changed, a Natrelle FM implant, 235 ml (profile 4.0 cm, width 10.5 cm, height 10.5 cm). The notch is sutured with Vicril 4-0 thread, with a stitch length of 5.0 mm. At the request of the patient, Tissucol Kit fibrin glue is used.

The postoperative condition of the patient (control of body temperature and area of operation, ESR) is presented in Table 3.

In FIG. Figures 6 and 7 show the dynamics of the biomechanical characteristics of the skin of the breast (elasticity and relaxation) - before (I), before (II) and after surgery (III), i.e. 12 days before surgery before Botox injection, on the day of surgery and 5 days after surgery).

Postoperative condition

On the 2nd and 3rd day of well-being - slight discomfort in the area of the breast; examination on the 5th day: swelling is practically absent, the presence of bruises (hematomas) is negligible, the healing in the area of bonding of the skin of the areola is primary, complete.

The rehabilitation period after the operation took 4 days - 1 day in the hospital and 3 days outpatient monitoring (the patient was in the hospital without restricting activities). Compression underwear was used within 10 days after surgery. The rehabilitation period was practically not accompanied by pain and swelling.

The postoperative condition of the patient after 2 and 4 months is shown in Photos 11 and 12, respectively: complete healing in the areas of cuts, scars and scars are absent, the degree of correction is complete with a pronounced cosmetic effect.

As can be seen from the examples of the method, confirmed by illustrative material and comparison with the prototype, the claimed invention provides: high aesthetic and long-lasting cosmetic effect, eliminates the appearance of a scar at the incision site, as well as reducing the time of postoperative rehabilitation (hospitalization or outpatient monitoring) and minimizes or excludes postoperative pain, the manifestation of local inflammatory processes and postoperative discomfort.

Information sources

1. RU 2134071 C1, M. cl. A61B 17 / 00.10.08.1995.

2. RU 2180803 C1, M. cl. A61B 17/00, 03/27/2002.

3. RU 2521346 C1, M. cl. A61B 17/00, 12/27/2014 - prototype.

Claims (3)

1. The method of breast plastic surgery (MF) in case of micromastia includes cutting the skin along the areola, penetrating through the incision into the retromammary space, forming the cavity under the implant, draining the cavity, placing the fibrin glue into the cavity, imparting the desired form to the MF, fixing it and suturing and gluing of the incision, characterized in that 12-14 days before the operation, the MF surface is marked into squares with a side length of ~ 2.0 cm and a mesh is applied, in the center of each square Botox injection from and 2.0-2.5 units. per square, Botox is also injected into the pectoralis major muscle at the rate of 20-30 units. on the muscle, in addition, during the operation, before placing the implant in the formed cavity, Botox is injected again at the rate of 20-30 units. on the muscle in the base and along the fibers of the pectoralis major muscle, fibrin glue is used in a mixture with a solution of an underpolarizing muscle relaxant, and the cavity is washed with an antibiotic solution before drying. 2. The method of breast plastic surgery according to claim 1, characterized in that long-acting peripheral muscle relaxants are used as non-polarizing muscle relaxant. 3. The method of breast plastic surgery according to claim 1, characterized in that aminoglycoside antibiotics are used as an antibiotic for washing the cavity under the implant.

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