RU2700259C1 - Method for preventing cosmetic defect with true gynecomastia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery. Skin is separated along with the nipple and areola until the dermal reticular layer. Incision is made along the lower edge of the areola, which is equal to 1/2 of the length of its circumference. Mammary gland is separated from the lower edge. Then posterior surface of mammary gland is separated through retromammary space; front, upper and lateral sections of mammary gland are successively released. After mammary gland is removed around the formed crater-like defect is separated from skin by 3–5 cm, leaving 1 cm of subcutaneous fat thickness, after separation subcutaneously fatty tissue is closed and contracted, shifting subcutaneous fat in the defect area until it is filled.

EFFECT: method enables eliminating the occurrence of crusiform deformations on the anterior chest wall due to the resulting tissue deficit after mammary gland removal, reducing wound healing time, improving the cosmetic result of the surgical intervention.

1 cl, 1 ex, 8 dwg

Description

The invention relates to medicine, namely to surgery in the technique of surgical intervention with true unilateral gynecomastia.

Known works on the choice of access to glandular tissue during mastectomy in men (Milo I.O. et al. Sexual correction for transsexualism. Moscow, 1999, pp. 46-64).

A known method of surgical treatment of gynecomastia, including performing a subareolar skin incision and removing the mammary gland through this access, followed by suturing the wound (K.U. Ashcraft, T.M. Holder, Pediatric Surgery. T. III, - S-P .: ICP " Hardford, 1996, pp. 292-293).

Criticism of analogues

The disadvantage of these methods is the formation of a cavity at the site of excised tissue, especially in obese patients, which leads to prolonged lymphorrhea, suppuration of the wound or the formation of a cosmetic defect in the form of entrapment. In addition, the known method does not take into account such a complication as the occurrence of crater-like deformations on the anterior chest wall due to a tissue deficiency after removal of the mammary glands, which significantly worsens the cosmetic result of the operation.

As a prototype, we took the method according to patent 2217071, author Chernomazov V.N.

Method - prototype is as follows:

Depending on the size of the tumor, the operation is performed under general or local infiltration anesthesia. For small breast sizes, local anesthesia is preferred, as injection of anesthetic allows hydraulic preparation of the gland from the skin.

On a submammary fold, a semi-oval or straight skin incision is made.

Separation of the skin is carried out together with the nipple and areola up to the reticular layer of the dermis, the breast tissue is removed along with the adjacent fatty tissue and fascia of the pectoralis major muscle.

During the operation, hemostasis is performed. The drainage of the residual wound cavity is carried out due to the sewn hem catgut to the pectoralis major muscle and active drainage removed through a separate puncture of the skin.

Suturing the edges of the postoperative wound is done by applying an intradermal suture.

Active drainage is removed for 3-4 days, the intradermal suture - for 7-8 days after surgery.

Prototype criticism

The disadvantage of the prototype method is the formation of a cavity at the site of excised tissue, especially in obese patients, which leads to prolonged lymphorrhea, suppuration of the wound or the formation of a cosmetic defect in the form of entrapment. In addition, the known method does not take into account such a complication as the occurrence of crater-like deformations on the anterior chest wall due to a tissue deficiency after removal of the mammary glands, which significantly worsens the cosmetic result of the operation.

The purpose of the invention:

The aim of the invention is to eliminate the occurrence of crater-like deformations on the anterior chest wall due to a tissue deficiency after removal of the mammary glands, reducing the healing time of the wound, improving the cosmetic result.

The invention:

The invention is illustrated in FIG. 1, where pos. 1 - cut line.

The essence of the invention lies in the fact that in the method of surgical treatment of gynecomastia, including making an incision along the edge of the areola, isolating the mammary gland with the intersection of the central milk duct, removing it with a single block, followed by transposition of nearby adipose tissue, filling the crater-shaped defect and suturing the wound, the incision is performed according to the lower edge of the areola, equal to 1/2 of its circumference (Fig. 1, pos. 1). Breast excretion begins from the lower edge, then its posterior surface is separated through the retro-mammary space, the front, upper and side sections are sequentially released (photo 2), after removing the mammary gland, the fiber around the resulting crater-shaped defect is separated from the skin by 3-5 cm leaving 1 cm thickness of subcutaneous adipose tissue for further transposition in the bed of the removed mammary gland (photo 3, 4, 5). After separation of the subcutaneous adipose tissue, it is sutured and pulled together, displacing the subcutaneous fat to the area of the defect until it is filled (photo 6), while the connective tissue adhesions that deform the skin when the fat is moved cross. Through a separate puncture along the anterior axillary line, a drainage is established to the bed of the removed gland; after suturing the wound, an elastic pressure bandage is applied to the chest. Pictures 7 and 8 show long-term results 7 days after surgery.

A subareolar incision (along the lower edge of the areola) passes along the border of the pigmented skin, which makes the scar that forms in the subsequent one invisible against this background. Violation of the trophic areola is avoided by maintaining smooth muscle fibers in the nipple complex, which are not stitched according to the proposed method, unlike the known method. Uniform reduction of subcutaneous tissue around the circumference of the defect with a purse string suture prevents crater-like deformations on the anterior chest wall. Fiber mobilization is achieved by crossing only connective tissue fusions that deform the skin when the fat layer is moved, which reduces trauma and reduces the number of complications such as bleeding, hematomas and seromas, ischemic damage to the areola and skin around it.

The method is as follows.

Surgical intervention is performed under general or local anesthesia. The operation begins with a lunar subareolar incision along the lower edge of the areola directly along the border of the pigmented skin. The cut length is 1/2 the circumference of the areola. The capsule of the mammary gland, which is separated from the areola, is exposed, the central milk duct is crossed. At the same time, they adhere to minimal trauma to smooth muscle fibers in the nipple complex. Then, in a blunt and sharp way, moving along the capsule of the mammary gland, the last of the surrounding fiber is secreted. First, its lower edge, closest to the skin wound, is released. Then, lifting it, they enter the retromammary space, thus separating the posterior surface of the gland from the muscles of the chest wall. Next, the front, side and upper sections are subsequently released. Remove the mammary gland in a single block without damaging the capsule. Check its integrity and conduct a visual and palpation revision of the wound to confirm the radical operation and thorough hemostasis. Fiber around the resulting crater-shaped defect is separated from the skin by 3-5 cm leaving 1 cm of subcutaneous fatty tissue thickness for further transposition in the bed of the removed breast. At the same time, connective tissue adhesions that deform the skin when moving fat cross. Spend hemostasis. Through a separate puncture along the front axillary line to the bed of the removed gland, a rubber graduate is installed for drainage. The wound is sutured with an intradermal cosmetic suture (atraumatic absorbable suture (Vikril) 3-4). The operation is completed by applying an aseptic and pressure bandage to the chest using an elastic bandage of medium stretch. The dressing is changed after 1 day and then every day. Rubber graduates tighten and remove in the absence of detachable after 2-3 days. Then carry out a control puncture of the operating area and the evacuation of liquid accumulations, if any. Patients wear a pressure bandage for three weeks, bandaging the chest 2 times a day with an elastic bandage. During the same time, physical activity is limited, and then physiotherapy exercises aimed at developing the muscles of the chest and shoulder girdle are prescribed. From the second week of the postoperative period, anti-scar treatment is carried out (gel and ointment “contractubex” 2 times a day for a scar - 1 month).

An example of a specific implementation of the method

Patient A., born 1999

Upon receipt of a complaint about the presence of education in the left mammary gland From the anamnesis, he considers himself a patient within 3-4 months. Not treated. Recently, I noticed an increase and pain appeared, in connection with which I turned to the TMT at the place of residence. From where he was sent to the ROD for further examination and treatment of Status localis .. In the zaoleolar zone of the left mammary gland, palpations without clear cuts up to 3 cm in diameter are palpated. Mobile painless .. There are no skin symptoms .. Regional lymph nodes are not enlarged.

Surveys

RW, BH4, HBS, HCV from. 01,2018 - negative.

X-RAY OF LUNG FLG from 11,2017 - no focal changes

Cytology from 20,10,2017 - cubic epithelium

Urologist consultation from - 15,01,2018 - no pathology detected

Ultrasound m / f - from 12,01,2018 - gynecomastia

Ultrasound of the liver from 18,01,2018 without focal changes.

X-ray of the Turkish saddle from 18.01,2018 - without pathology

TREATMENT TREATED - 23.01,2018 - subcutaneous amputation of the left mammary gland. Results of other studies. Histotvet from 24.01,2018 - No. 1030 - cystic dilated ducts, with focal proliferation of the epithelium among fibrous tissue. Supervision of the oncologist at the place of residence, appearance at the control after 3 months is discharged in satisfactory condition with recommendations.

D \ G Gynecomastia on the left. Condition after surgery, cl gr 1b

Patient S. 1950

was on treatment from 09.04.2012 to 21.04.2015

Upon receipt of a complaint, the presence of education in the left mammary gland

Anamnesis considers himself sick within 3-4 months. Not treated. Recently, I noticed an increase and pain appeared, in connection with which I turned to Tmo at the place of residence. From where was sent to the ROD for additional examination and treatment

Status localis .. In the periolar region of the left mammary gland, seals are palpated without clear cuts up to 3 cm in diameter. Mobile painless .. There are no skin symptoms .. Regional lymph nodes are not enlarged.

Surveys

RW, BH4, HBS, HCV from. 04,2015 - negative.

X-RAY OF LUNG FLG from 03,2015 - no focal changes

X-ray of the Turkish saddle from 04,2015 normal

Cytology from 03,2015 - cubic epithelium

Urologist consultation from - 03,2015 - without pathology, gynecomastia on the left

Ultrasound of the liver from 03,2015 - no focal changes

CONSULTATION OF THE ENDOCRINOLOGIST OF 03, 2015 gynecomastia on the left.

Ultrasound of the mammary glands - from 08.04.2012 - a picture of gynecomastia on the left

TREATMENT WAS TREATED - 14.04,2015 - subcutaneous amputation of the left mammary gland. Results of other studies. Histotvet from 15.04,2015 No. 1335-42 - gynecomastia with the phenomena of fibrocystic mastopathy.

Supervision of the oncologist at the place of residence, appearance at the control after 3 months is discharged in satisfactory condition with recommendations.

D \ G Gynecomastia on the left. Condition after surgery, cl gr 1b

Features of the invention, distinctive from the prototype

1. perform a cut along the lower edge of the areola, equal to 1/2 of its circumference,

2. start breast secretion from the lower edge,

3. through the retro-mammary space, the posterior surface of the mammary gland is separated, the front, upper and side sections of the mammary gland are sequentially released,

4. after removal of the mammary gland, the fiber around the formed crater-shaped defect is separated from the skin by 3-5 cm leaving 1 cm of the thickness of the subcutaneous fat for further transposition in the bed of the removed breast

5. connective tissue adhesions that deform the skin when moving fat cross;

6. through a separate puncture along the front axillary line to the bed of the removed gland, drainage is established,

7. After suturing the wound, an elastic pressure bandage is applied to the chest.

The positive effect of the invention:

A positive effect of the invention is to reduce the healing time of the wound, increase the cosmetic result, eliminate the occurrence of crater-like deformations on the anterior chest wall due to tissue deficiency after removal of the mammary glands. A high and reliable cosmetic effect is achieved with minimal trauma. The functional elastic properties of the areolar complex, which determine the presence of a nipple reflex after surgery, which is normal, are preserved. The method prevents noticeable gross scars after surgery, deformation, necrosis, atrophy of the areola, nipple and skin of this area, crater-shaped defects on the chest wall that inevitably form after removal of the mammary glands. Gynecomastia recurrence is excluded. In addition, the method reduces the number of complications such as the occurrence of hematomas and seromas in the postoperative period, improves healing and adaptation of the edges of the wound, prolonged wearing of an elastic pressure dressing.

The achieved result significantly improves the psychosocial rehabilitation of patients with gynecomastia, sexual adaptation in the future of patients with impaired sexual differentiation, registered in the male field of education, thereby improving their quality of life.

Information taken into account:

Chernomazov V.N. Patent 2217071 - Prototype

Claims (1)

A method of surgical treatment of gynecomastia, including the separation of the skin along with the nipple and areola up to the reticular layer of the dermis, characterized in that an incision is made along the lower edge of the areola equal to 1/2 of its circumference, the breast is excreted from the lower edge, then through the retromammary space separate the posterior surface of the mammary gland, sequentially release the front, upper and side sections of the mammary gland, after removing the mammary gland, fiber around the resulting crater-shaped defect they are separated from the skin by 3-5 cm, leaving 1 cm of the thickness of the subcutaneous fat, after separation of the subcutaneous fat, it is sutured and tightened, displacing the subcutaneous fat into the defect until it is filled.

Images