RU2750272C1 - Method for reduction mammaplasty in macromastia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to plastic surgery. An inverted T-shape pattern incision is made. De-epidermisation of the superior medial dermal pedicle is the performed para-areolarly from 12 o'clock to the lower third of the medial vertical incision. Resection of the mammary gland is performed in the area from 12 o'clock para-areolarly and laterally along the skin incision line, in the lower pole along the submammary incision and medially to the lower third of the vertical incision. The nipple-areola complex is turned 130 degrees from the outside inward, and the edge of the areola is fixed to the edge of the skin at 12 o'clock.

EFFECT: method allows removing a sufficient volume of mammary tissue in order to perform layer-by-layer postoperative suturing without critical tension on the edges of the wound, and the space created during resection allows laying the feeding pedicle of the nipple-areola complex without tension on the surrounding tissue, excluding possibility of necrosis and denervation thereof due to retained neurovascular bundles in the superior medial dermal pedicle.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely to aesthetic surgery, and can be used in the technique of reduction mammoplasty.

Breast reduction technology includes wide mobilization of the skin over the gland, wedge-shaped excision of its excess, followed by transposition of the nipple-areola complex on the parenchymal (usually the central feeding pedicle and rotation of the remaining glandular tissue to give the organ a more conical shape (Arie, Pitanguy, Hester) ...

However, the disadvantages of this method are the removal of glandular tissue only in the region of the lower pole, and in the case of severe hyperplasia of the mammary glands, a high degree of tension of the edges of the skin wound and subsequent necrosis of the skin with the formation of ligature fistulas and gross cicatricial deformities are formed.

The method of removing the lower pole of the mammary gland with free transplantation of the areola and nipple was proposed by M. Thorek in 1922 (modified by Rubin, 1983). The operation is shown:

1) in older women, to shorten the time of intervention;

2) in women with overweight and severe ptosis;

3) in situations where it is required to remove more than 1500-2000 gr. each gland (with gigantomastia).

However, the disadvantage of this method is frequent necrosis, complete denervation and cicatricial deformation of the nipple-areola complex, and the inability to provide aesthetic symmetry.

The objective of the proposed method: to remove a large volume of the mammary gland while preserving the nipple-areola complex.

The task is carried out due to the fact that de-epidermisation of the superior-medial dermal leg is carried out para-areolar from 12 hours to the lower third of the medial vertical incision, resection of the mammary gland is performed in the zone from 12 hours para-areolar and lateral along the line of skin incisions, in the lower pole along the submammary incision and medially to the lower third of the vertical incision, the nipple-areola complex is turned 130 degrees from outside to inside and the edge of the areola is fixed to the edge of the skin at 12 o'clock.

The method is carried out as follows:

An incision is made according to a previously made marking in the form of an inverted T. The areola diameter is 4.5 cm. The new position of the areola and nipple corresponds to the level of the submammary fold at a distance of 20 +/- 2 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then de-epidermisation of the superior medial dermal pedicle is performed para-areolar from 12 hours to the lower third of the medial vertical incision. Resection of the mammary gland is performed in the zone from 12 o'clock para-areolar and laterally along the line of skin incisions, in the lower pole along the submammary incision and medially to the lower third of the vertical incision. The nipple-areola complex is turned 130 degrees from outside to inside and the edge of the areola is fixed to the edge of the skin at 12 o'clock. The leg of the nipple-areola complex is placed in a free position in place of the removed tissue. The postoperative wound is sutured in layers with the formation of a periareolar suture, a vertical suture from the edge of the areola to the submammary fold and a semilunar suture in the projection of the submammary fold from 4 to 8 hours.

Patient N., 49 years old, on admission complained about the large size of the mammary glands (Fig. 1). Operation: Before the operation, the markup was performed according to the scheme. The operation was performed under general anesthesia. An incision is made according to a previously made marking in the form of an inverted T. The areola diameter is 4.5 cm. The new position of the areola and nipple corresponds to the level of the submammary fold at a distance of 20 +/- 2 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm.Then de-epidermis of the superior medial dermal pedicle is performed para-areolar from 12 hours to the lower third of the medial vertical incision (2). Resection of the mammary gland is performed in the zone from 12 o'clock para-areolar and laterally along the line of skin incisions, in the lower pole along the submammary incision and medially to the lower third of the vertical incision (Fig. 3). The nipple-areola complex is rotated 130 degrees on the dial from outside to inside and the edge of the areola is fixed to the edge of the skin at 12 o'clock (Fig. 4). The leg of the nipple-areola complex is placed in a free position in place of the removed tissue to preserve nutrition. The postoperative wound is sutured in layers with atraumatic monofilament "Biosin" USP 3-0 with the formation of a periareolar suture, a vertical suture from the edge of the areola to the submammary fold and a semilunar suture in the projection of the submammary fold from 4 to 8 hours. Careful control of hemostasis made it possible to complete the operation without subcutaneous and retromammary drainage. The aseptic dressing was fixed with compression garments.

On the 10th day: The condition is satisfactory. No complaints. Healing per prima. The stitches have been removed. Areoles of normal color, sensitivity is preserved.

After 3 months: There are no aesthetic complaints after mammoplasty (Fig. 5).

EFFECT: method allows to remove a sufficient volume of breast tissue in order to produce layer-by-layer imposition of postoperative sutures without critical tension of the wound edges, and the created space during resection allows to lay the feeding pedicle of the nipple-areola complex without tension of the surrounding tissues, which excludes the possibility of necrosis and denervation due to preservation neurovascular bundles in the superior medial dermal pedicle.

Claims (1)

The method of reduction mammoplasty for gigantomastia, characterized by performing an incision according to an inverted T-shaped scheme, then de-epidermisation of the upper medial dermal leg is performed para-areolar from 12 hours to the lower third of the medial vertical incision, resection of the mammary gland is performed in the zone from 12 hours para-areolar and lateral along the incision line skin, in the lower pole along the submammary incision and medially to the lower third of the vertical incision, the nipple-areola complex is turned 130 degrees from the outside to the inside and the edge of the areaola is fixed to the edge of the skin at 12 o'clock.

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