RU2751929C1 - Breast reconstruction method - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to plastic surgery, reconstructive surgery, oncology. A monoblock musculo-dermal expander pocket is formed in case of delayed reconstruction or a musculo-glandular expander pocket in case of correction of tubular deformity of the breasts. A tissue expander with a built-in port is placed submuscularly. The tissue expander is filled with sterile saline through the built-in port weekly for one month. One month after the installation of the tissue expander at the preoperative stage, the recipient zone of the restored breast and donor zones are marked. During the operation, 50% of the tissue expander volume is evacuated through the built-in port, tumescent infiltration of donor zones is performed, exposure is performed, lipoaspirate is taken in an amount equal to three volumes of the reduced part of the tissue expander, the resulting lipoasprate is centrifuged. Subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in the amount of one and a half volumes of the reduced part of the tissue expander. Three months later, at the preoperative stage, the recipient zone of the restored breast and donor zones are marked. Marking of the percutaneous circular blocking return suture is performed relative to the healthy breast in the case of delayed reconstruction and relative to the true spot of breasts in the case of correction of tubular deformity. During the operation, the tissue expander of the reconstructed breast is removed. Tumescent infiltration of donor areas is performed. Lipoaspirate is taken in the amount of three volumes of the removed tissue expander. The obtained lipoaspirate is centrifuged, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in the amount of one and a half volumes of the removed tissue expander. In this case, the tissue expander capsule acts as the main matrix for the transplanted adipose tissue. Two-plane liposuction of the skin of the lower one third of the chest on the side of reconstruction is performed, using a suture needle, two percutaneous circular recurrent blocking sutures are applied, the suture material is carried out subcutaneously parasternally on a segment from the subclavian region to the medial border of the submammary sulcus, in the projection of the marked submammary sulcus, continue intramuscularly on the segment from the lateral border of the submammary groove to the subclavian region is carried out deeply subcutaneously along the mid-axillary line. On a segment from the subclavian region to the axillary region, the suture material is passed subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component. In this case, the periosteum of the sternum and the lateral edge of the pectoralis major muscle act as the fixation points of the percutaneous circular recurrent blocking suture. Further, in the cranial direction, traction of the soft tissues of the lower slope of the reconstructed breast is performed, thereby forming the submammary groove, the external and internal contours of the breast, and the degree of ptosis and the clarity of the topographic landmarks of the reconstructed breast are regulated by the tightening force of the circular blocking suture, the operation ends with layer-by-layer wound closure.EFFECT: allows increasing the recipient capacity of the restored breast, as well as restoring all its topographic landmarks (inner contour, submammary sulcus, outer contour).1 cl, 17 dwg, 2 ex

Description

The proposed invention relates to the field of medicine, namely, plastic surgery, reconstructive surgery, oncology.

Today, two main methods of breast reconstruction are widely used in clinical practice: two-stage reconstruction using an expander and a permanent implant (79%), as well as the use of full-thickness complex autografts (12%) from various donor areas. Each of the above methods has its own indications and contraindications for their use, "strengths" and "weaknesses" (The Number of Operations Required for Completing Breast Reconstruction Jin Sup Eom, MD, PhD, corresponding author Mark Robert Kobayashi, MD, Keyianoosh Paydar , MD, FACS, Garrett A. Wirth, MD, MS, FACS, and Gregory RD Evans, MD, FACS / Plast Reconstr Surg Glob Open. 2014 Oct; 2 (10): e242).

The likelihood of an inadequate result from an aesthetic point of view after performing traditional reconstructive surgeries aimed at breast reconstruction remains in view of the rather high frequency of specific complications. So, for the two-stage expander-implant method, the frequency of such complications in the period up to 1 year according to various sources is 5.9-13%, and for methods using full-thickness complex grafts in the period up to 2 years, this figure reaches 32.9% ( Complications in Postmastectomy Breast Reconstruction One-year Outcomes of the Mastectomy Reconstruction Outcomes Consortium MROC Study Edwin G. Wilkins, MD, MS, Jennifer B. Hamill, MPH, Hyungjin M. Kim, ScD, John Y. Kim, MD, Richard J. Greco , MD, Ji Qi, MS, and Andrea L. Pusic, MD, MHS / Ann Surg. Author manuscript; available in PMC 2018 Apr 18. Published in final edited form as: Ann Surg. 2018 Jan; 267 (1): 164 -170; Comparison of 2-Year Complication Rates Among Common Techniques for Postmastectomy Breast Reconstruction Katelyn G Bennett, Ji Qi, Hyungjin M Kim, Jennifer B Hamill, Andrea L Pusic, Edwin G Wilkins / 2018 Oct 1; 153 (10): 901 -908.doi: 10.1001 / jamasurg.2018.1687).

In modern scientific literature and at international symposia devoted to the problems of reconstructive surgery of the breast, it is very delicate and with some caution that it is said about alternative methods of restoring the contour of a lost organ, followed by a staged reconstruction of the volume. However, the most difficult task from the point of view of obtaining a good aesthetic result is precisely the reconstruction of the correct and harmonious breast contour, rather than its volume.

There is no need to talk about the advantages of your own tissue over synthetic materials or implants. Transplantation of own adipose tissue was introduced into clinical practice in the last century, however, it was underdeveloped due to the lack of theoretical justification and a proven method of use, which led to the development of an unpredictable result. But the accumulation of clinical experience and experimental data made it possible to develop conditions for obtaining positive clinical results.

Currently, there is no clear algorithm for breast reconstruction using the technology of volumetric transplantation of autologous adipose tissue, which provides a stable and predictable aesthetic postoperative result.

There is a known method of reconstruction of the mammary gland, including restoration of the volume of the mammary gland with its own fatty tissue and stretching the tissues in place of the formed breast, a gradual decrease in the volume of the previously installed Becker implant with simultaneous replacement of the volume of the mammary gland with its own fatty tissue harvested from the donor zones of the patient, while through the valve in the Becker implant, a part of the volume of saline with which the Becker implant is filled is evacuated from its cavity, fatty tissue harvested and prepared by the Coleman method is injected along the contour of the breast tissue, then compression underwear is put on the donor sites for the collection of fatty tissue for 3 weeks, a course of replacement of the volume of milk the glands are repeated up to 5 times with an interval between courses of at least 3 months and continue until the complete removal of saline from the internal cavity of the Becker implant, remove the Becker implant and replace the internal volume with milk th gland with its own adipose tissue until it reaches the size of a healthy breast (patent No. 2562098, A61B 17/00, op.10.09.2015, BI No. 25).

The disadvantage of this method is that the Becker implant has a low efficiency of extension in conditions of pronounced post-radiation fibrosis, because has less pronounced frame properties in contrast to a tissue expander with a built-in port. There are clinical cases with an extreme deficiency of integumentary tissues in the area of interest, which makes it impossible to install (without complementing the operation with full-thickness complex autografts) of the Becker implant, since part of the volume of this implant is represented by a cohesive gel. The fact that the initial volume of the Becker implant is present limits the possibility of creating additional planes of adipose tissue transplantation. This circumstance explains the need for multiple sessions of autologous adipose tissue transplantation to achieve the desired volume of the reconstructed breast in the case of the primary Becker implant. Also, this method of reconstruction implies restoration of only the volume of the reconstructed breast, which discredits it as an independent reconstruction method, since the aesthetic appearance of the mammary gland is determined not only by volume, but also by clear, correct contours. The submammary sulcus, inner and outer contours are integral parts of the aesthetic perception of the mammary gland, the reconstruction of which should be indicated as one of the main stages of breast reconstruction.

There are many techniques for reconstructing the submammary sulcus, most of them based on plication of the fibrous capsule sheets. Many of these techniques are widely used in clinical practice and give good aesthetic results. However, in some cases, a thin fibrous capsule is formed around the endoprosthesis, which does not allow adequate formation of the submammary sulcus.

The objective of the present invention is to effectively restore the shape and size of the mammary glands.

The technical result of the invention consists in increasing the recipient capacity of the restored mammary gland, as well as in restoring all its topographic landmarks (inner contour, submammary groove, outer contour).

The technical result is achieved by the fact that the method of reconstruction of the mammary glands includes marking the position of the tissue expander relative to the healthy breast in the case of delayed reconstruction and relative to the true spot of the mammary glands in the case of correction of tubular deformity of the mammary glands at the preoperative stage, using endoscopic equipment, a monoblock musculo-dermal pocket is formed expander in case of delayed reconstruction or musculo-glandular pocket of the expander in case of correction of tubular deformity of the mammary glands, a tissue expander with a built-in port is inserted submuscularly, the tissue expander is filled with sterile saline through the built-in port weekly for at least one month, at least , one month after the installation of the tissue expander at the preoperative stage, the recipient zone of the restored breast and donor zones are marked, during the operation through the built-in pore t of the tissue expander, at least 50% of its volume is evacuated, tumescent infiltration of donor zones is performed, exposure is performed, lipoaspirate is taken in an amount equal to at least three volumes of the reduced part of the tissue expander, the resulting lipoasprate is centrifuged, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue in an amount of at least one and a half volumes of the reduced part of the tissue expander; in the case of delayed reconstruction and a relatively true spot of the mammary glands in the case of correction of tubular deformity, during the operation, the tissue expander of the reconstructed breast is removed, tumescent infiltration of donor zones is performed, lipoaspirate is taken in an amount of at least three volumes of the removed tissue expander, the obtained lipoasprate is centrifuged, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in an amount of at least one and a half volumes of the removed tissue expander, with the main matrix for the transplanted fat tissue the capsule of the tissue expander protrudes, perform biplane liposuction of the skin of the lower one third of the chest on the side of reconstruction using a suture needle, impose at least two percutaneous circular recurrent blocking sutures, pass the suture material subcutaneously parasternally on a segment from the subclavian region to the medial border of the submammary the grooves, in the projection of the marked submammary groove, continue intradermally, in the segment from the lateral border of the submammary groove to the subclavian region, they are carried out deeply subcutaneously along the midaxillary line, in a segment from the subclavian region As far as the axillary region, the suture material is carried out subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component, while the periosteum of the sternum and the lateral edge of the pectoralis major muscle act as fixation points for the percutaneous circular recurrent blocking suture, then in the cranial direction traction of soft tissues is performed the lower slope of the reconstructed mammary gland, thereby forming the submammary groove, the outer and inner contours of the breast, and the degree of ptosis and the clarity of the topographic landmarks of the reconstructed mammary gland are regulated by the tightening force of the circular blocking suture, the operation ends with layer-by-layer wound closure.

Thanks to the submuscular installation of a tissue expander with a built-in port and the use of the formed fibrous capsule as the main matrix for the transplanted adipose tissue, additional planes of transplantation of own adipose tissue (subdermal, intramuscular, paracapsular) have appeared. Execution of a percutaneous circular blocking return suture with three combined fixation points (sternum periosteum, lateral edge of the pectoralis major muscle No. 2), as well as the implementation of good skin mobility of the lower 1/3 of the chest on the reconstruction side by means of superficial and deep liposuction made it possible to restore all topographic landmarks (inner contour, submammary groove, outer contour) of the restored breast.

The attached figure 1 shows a tissue expander with formed recipient planes (subdermal, intramuscular, paracapsular) of the restored breast; in fig. 2 - complete restoration of breast volume after the second session of volumetric transplantation of autologous adipose tissue, filled recipient planes; in fig. 3 - two-plane liposuction of the skin of the lower 1/3 of the chest on the side of the reconstruction in order to realize good mobility and unhindered redrafting of the lower slope of the reconstructed breast; in fig. 4 - points of fixation of the percutaneous circular returnable blocking suture; in fig. 5 - photo of the patient after a mastectomy on the right; in fig. 6 - a photo of a patient with an expander installed and marked with markings before an intermediate stage of reconstruction of the right breast; in fig. 7 - photo of a patient with partial replacement of the tissue expander volume with her own adipose tissue and applied markings before the final stage of reconstruction; in fig. 8 - photo of the result of delayed reconstruction of the right breast using the "volume-sling" method 1 year after the final stage of the operation; in fig. 9a - preoperative photo of a patient with grade III tubular deformity of the right breast, front view; in fig. 9b - preoperative photo of a patient with grade III tubular deformity of the right breast, right side view in 3/4 profile; in fig. 9c - preoperative photo of a patient with grade III tubular deformity of the right breast, left side 3/4 profile; in fig. 10 - photo of the patient with the marking of the position of the tissue expander; in fig. 11 - photo of a patient with partial replacement of the volume of the expander of the right breast with her own adipose tissue; in fig. 12 - photo of the patient with the markings applied before the final stage of aesthetic correction of tubular deformity of the right breast; in fig. 13a - photo of a patient with the result of aesthetic correction of tubular deformity of the right breast using the "volume-sling" method 1 year after the final stage of the operation, front view; in fig. 13b - photo of a patient with the result of aesthetic correction of tubular deformity of the right mammary gland using the “volume-sling” method 1 year after the final stage of the operation, right side view in 3/4 profile; in fig. 13c - photo of the result of aesthetic correction of tubular deformity of the right breast using the "volume-sling" method 1 year after the final stage of the operation, left side view ¾ profile.

The method is carried out as follows.

At the preoperative stage, the position of the tissue expander 1 is marked with respect to the healthy breast in the case of delayed reconstruction and relative to the true spot of the mammary glands in the case of correction of tubular deformity of the mammary glands. Using endoscopic equipment, a monoblock musculo-dermal (in case of delayed reconstruction) or musculo-glandular (in case of correction of tubular deformity) tissue expander pocket is formed. A tissue expander 1 with a built-in port 2 is installed in the formed pocket. Through the built-in port 2, the tissue expander 1 is filled with sterile saline (0.9% NaCl) weekly for 1 month. FIG. 1 schematically shows a tissue expander 1 with formed recipient planes (subdermal 3, intramuscular 4, paracapsular 5) of the restored breast. One month after the installation of the tissue expander 1, the second stage of reconstruction is performed. At the preoperative stage, the recipient zone of the restored breast and donor zones (most often the mesogastric region, abdominal flanks, inner and outer thighs, lumbar region) are marked. During the operation, 50% of the tissue expander volume is evacuated through the built-in port 2. Tumescent infiltration of donor areas with Klein solution is performed. Exposure 10 minutes. Using a vibration action apparatus and a 3 mm cannula, lipoaspirate is taken in an amount equal to three volumes of the reduced part of tissue expander 1. The resulting lipoasprate is centrifuged (1300 rpm for 1.5 minutes). Using a 1.5 mm curved cannula and a retrograde technique, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in an amount equal to 1.5 volumes of the reduced part of the tissue expander. After 3 months, the final stage of breast reconstruction is performed. At the preoperative stage, the recipient zone of the restored breast and donor zones are marked relative to the healthy breast (in the case of delayed reconstruction) and relative to the true spot of the mammary glands (in the case of correction of tubular deformity), the percutaneous circular blocking return suture is marked. During the operation, the tissue expander 1 of the reconstructed breast is removed. Tumescent infiltration of donor areas with Klein solution is performed. Exposition 10 minutes. Using a vibrating apparatus and a 3 mm cannula, lipoaspirate is taken in an amount equal to three volumes of the removed expander 1. The resulting lipoasprate is centrifuged (1300 rpm for 1.5 min). Using a 1.5 mm curved cannula and a retrograde technique, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in an amount equal to 1.5 volumes of the removed expander 1, with the tissue expander 1 capsule acting as the main matrix for the transplanted adipose tissue. FIG. 2 schematically depicts the complete restoration of breast volume after the second session of volumetric transplantation of autologous adipose tissue, filled recipient planes 6.Using a vibrating device and a 4 mm cannula, two-plane liposuction of the skin of the lower 1/3 of the chest on the reconstruction side is performed to achieve good mobility and unimpeded redrapping the lower slope of the restored mammary gland (Fig. 3). Using a suture needle with a minimum length of 18 cm, two percutaneous circular return blocking sutures are applied with PDS 2 and Etibond 2.0 suture. The suture material on the segment from the subclavian region to the medial border of the submammary sulcus is carried out subcutaneously parasternally, in the projection of the marked submammary sulcus is continued intradermally, in the segment from the lateral border of the submammary sulcus to the subclavian region is carried deeply subcutaneously along the mid-axillary line, in the segment from the subclavian region to the axillary region the suture material is passed subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component of the circular blocking suture. The fixation points of the percutaneous circular recurrent locking suture are schematically shown in FIG. 4, they are the sternum periosteum and the lateral edge of the pectoralis major muscle. Further, in the cranial direction, traction of the soft tissues of the lower slope of the reconstructed mammary gland is performed, thereby forming the submammary groove, the outer and inner contours of the breast. The degree of ptosis and the clarity of the topographic landmarks of the reconstructed mammary gland are regulated by the tightening force of the circular locking suture, which makes it possible to obtain a symmetrical result immediately on the operating table. The operation is completed by layer-by-layer wound closure.

For clarity, the proposed method of reconstruction of the mammary glands is illustrated by clinical examples.

Example 1.

Delayed reconstruction of the right breast using the volume-sling method.

Patient M., 46 years old, diagnosis: cancer of the right breast pT1N0M0. In 2015, a Madden mastectomy was performed on the right. FIG. 5 shows a photo of the patient after a mastectomy on the right. On September 16, 2016, the first stage of the delayed reconstruction of the right breast was performed - a submuscular installation of a tissue expander with a built-in port. For one month, the tissue expander was filled with saline on a weekly basis in order to stretch the soft tissues and prepare the recipient zone. On 02.11.2016, an intermediate stage of the reconstruction of the right breast was carried out, which consisted in the fact that after marking the recipient zone of the restored breast and donor zones through the built-in port with a G18 needle, 50% of the volume of the tissue expander was evacuated. Using a vibrating apparatus and a 3 mm cannula, lipoaspirate was taken in an amount equal to three volumes of the reduced part of the expander, the resulting lipoasprate was centrifuged (1300 rpm for 1.5 min). Retrograde subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue in an amount equal to 1.5 volumes of the reduced part of the tissue expander was performed with a 1.5 mm cannula. FIG. 6 shows a photo of a patient with an expander installed and marked with markings before the intermediate stage of reconstruction of the right breast. On January 12, 2017, the final stage of reconstruction of the right breast was performed using the "volume-sling" method. FIG. 7 shows a photo of a patient with partial (50%) replacement of the expander volume with her own adipose tissue and applied markings before the final stage of reconstruction, the essence of which was that after marking the recipient zone of the breast to be reconstructed and donor zones, marking the relatively healthy breast of the percutaneous circular blocking recurrent suture, the tissue expander of the reconstructed breast was removed. Using a vibrating device and a 3 mm cannula, lipoaspirate was taken in an amount equal to three volumes of the removed expander, the resulting lipoasprate was centrifuged (1300 rpm, 1.5 min). A 1.5 mm curved cannula was used to perform retrograde subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue in an amount equal to 1.5 volumes of the removed tissue expander, with the tissue expander capsule being the main matrix for the transplanted adipose tissue. Using a vibrating device and a 4 mm cannula, we performed biplane liposuction of the skin of the lower 1/3 of the chest on the right in order to realize good mobility and unhindered redrafting of the lower slope of the right breast. Using a suture needle, two percutaneous circular recurrent blocking sutures with PDS 2 and Etibond 2.0 sutures were applied, the suture material in the segment from the subclavian region to the medial border of the submammary sulcus was carried out subcutaneously, parasternally, in the projection of the marked submammary sulcus, it continued intradermally, in the segment from the subclavian boron the area was carried out deeply subcutaneously along the mid-axillary line, on a segment from the subclavian region to the axillary region, the suture material was carried out subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component of the circular blocking suture, the latter was fixed to the periosteum of the sternum and the lateral edge of the pectoralis major muscle ... Further, in the cranial direction, traction was made on the soft tissues of the lower slope of the right breast, thereby forming a submammary groove, external and internal contours of the breast. The symmetry of ptosis and topographic landmarks of the reconstructed breast relative to the healthy one was regulated by the tightening force of the circular locking suture.

FIG. 8 shows a photo of the result of delayed reconstruction of the right breast using the "volume-sling" method 1 year after the final stage of the operation. The photo demonstrates the stability of the volume and the symmetry of the contours of the reconstructed breast. The results of the BREAST-Q survey showed a high degree of patient satisfaction with the performed reconstructive surgery.

Example 2.

Correction of tubular deformity of the left breast using the "volume-sling" method.

Patient F., 20 years old. Diagnosis: grade III tubular deformity of the right breast. FIG. 19 shows a preoperative photo of the patient (Fig. 9a - front view, Fig. 9b - right side view in 3/4 profile, Fig. 9c - left side view 3/4 profile). On 01/06/2016, the first stage of aesthetic correction of tubular deformity of the right breast was performed - a submuscular installation of a tissue expander with a built-in port. FIG. 10 shows a photo of the patient with the marking of the position of the tissue expander. For three weeks, the tissue expander was filled with saline in order to stretch the soft tissues and prepare the recipient zone. On 04.04.2016, an intermediate stage of aesthetic correction of tubular deformity of the right breast was performed, which consisted in the fact that after marking the recipient zone of the right breast and donor zones, 50% of the expander volume was evacuated through the built-in port with a G18 needle. Using a vibration apparatus and a 3 mm cannula, lipoaspirate was taken in an amount equal to three volumes of the reduced part of the tissue expander, the resulting lipoasprate was centrifuged (1300 rpm for 1.5 min). Retrograde subdermal, retromammary, intramuscular and paracapsular transplantation of the treated adipose tissue in an amount equal to 1.5 volumes of the reduced part of the tissue expander was performed with a 1.5 mm cannula. FIG. 11 shows a photo of a patient with partial (50%) replacement of the expander volume of the right breast with her own adipose tissue. 06/03/2016 completed the final stage of reconstruction of the right breast using the "volume-sling" method. FIG. 12 shows a photo of the patient with the markings applied before the final stage of aesthetic correction of tubular deformity of the right breast, the essence of which was that after marking the recipient zone of the breast to be reconstructed and donor zones, marking the percutaneous circular blocking return suture with respect to the left breast, the tissue expander the right breast was removed. Using a vibrating device and a 3 mm cannula, lipoaspirate was taken in an amount equal to three volumes of the removed expander, the resulting lipoasprate was centrifuged (1300 rpm for 1.5 min). A 1.5 mm curved cannula was used to perform retrograde subdermal, retromammary, intramuscular and paracapsular transplantation of the treated adipose tissue in an amount equal to 1.5 volumes of the removed tissue expander, with the tissue expander capsule being the main matrix for the transplanted adipose tissue. Using a vibrating device and a 4 mm cannula, we performed biplane liposuction of the skin of the lower 1/3 of the chest on the right in order to realize good mobility and unhindered redrafting of the lower slope of the right breast. Using a suture needle, two percutaneous circular return blocking sutures with PDS 2 and Etibond 2.0 sutures were applied, suture material was carried out subclavianly from the subclavian region to the medial border of the submammary sulcus, in the projection of the marked submammary sulcus, it was continued intradermally, in the segment from the subclavian boron the areas were carried out deeply subcutaneously along the mid-axillary line, on a segment from the subclavian region to the axillary region, the suture material was carried out subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component of the circular blocking suture, the latter was fixed to the periosteum of the sternum and the lateral edge of the pectoralis major muscle ... Further, in the cranial direction, traction was made on the soft tissues of the lower slope of the right breast, thereby forming a submammary groove, external and internal contours of the breast. The symmetry of ptosis and topographic landmarks of the corrected mammary gland relative to the contralateral one was regulated by the tightening force of the circular locking suture.

FIG. 13 shows a photo of the result of aesthetic correction of tubular deformity of the right breast by the "volume-sling" method 1 year after the final stage of the operation (Fig. 13a - front view, Fig. 13b - right side view in 3/4 profile, Fig. 13c - left view 3/4 profile). The result of aesthetic correction is stable, the reconstructed mammary gland does not differ from the contralateral one in its visual, tactile and dynamic characteristics. The results of the survey on the BREAST-Q scale also demonstrated a high degree of patient satisfaction with the performed corrective surgery.

The proposed method differs from the existing ones in that:

1. Installed submuscular tissue expander with built-in port does not have residual volume, unlike Becker's implant, which explains its greater efficiency in conditions of pronounced fibrosis and extreme deficiency of integumentary tissues in the area of interest. As a result, the use of a tissue expander with a built-in port facilitates tissue extension and expands the indications for carrying out reconstructive aids;

2. Submuscular installation of a tissue expander allows creating additional planes of adipose tissue transplantation, which significantly increases the volume of the recipient capacity. As a result, the full restoration of the volume of the reconstructed breast is carried out in just 2 sessions of transplantation of own adipose tissue, which significantly reduces the period of reconstructive treatment (from the initial treatment to the final result);

3. In the process of reconstruction of the mammary glands by the "volume-sling" method, not only the restoration of the volume, but also of all topographic landmarks of the lost organ is carried out through the percutaneous imposition of a circular blocking recurrent suture. The use of this technique allows the reconstruction of the inner contour, submammary sulcus, and the outer contour of the breast to be restored with the maximum aesthetic result, regardless of the state of the patient's tissues.

Thus, a new method of breast reconstruction has been proposed, which allows to restore the most natural shape and volume of the breast in the shortest possible time. The developed technology of volumetric transplantation of own adipose tissue and percutaneous restoration of the submammary sulcus made it possible to significantly simplify the process of breast reconstruction, as well as to reduce the cost of reconstructive treatment by eliminating the use of expensive imported implants. The method allows its extended use in hospitals of various levels, including regional ones. Reducing the cost of reconstructive treatment will make it possible to abandon the use of existing technologies based on the use of expensive imported implants.

Claims (1)

The method of breast reconstruction includes marking the position of the tissue expander relative to the healthy breast in the case of delayed reconstruction and relative to the true spot of the mammary glands in the case of correction of tubular deformity of the mammary glands at the preoperative stage, using endoscopic equipment, a monoblock musculo-dermal pocket of the expander is formed in the case of delayed reconstruction, or the musculo-glandular pocket of the expander in the case of correction of tubular deformity of the mammary glands, a tissue expander with an integrated port is submuscularly installed, the tissue expander is filled with sterile saline through the built-in port for one month, one month after the installation of the tissue expander at the preoperative stage, the recipient zone is marked of the restored breast and donor zones, during the operation, 50% of its volume is evacuated through the built-in port of the tissue expander, a tumescent infill is performed Donor zones are treated, exposure is performed, lipoaspirate is taken in an amount equal to three volumes of the reduced part of the tissue expander, the resulting lipoasprate is centrifuged, subdermal, intramuscular and paracapsular transplantation of the treated adipose tissue is performed in the amount of one and a half volumes of the reduced part of the tissue expander, after three months mark the recipient zone of the restored breast and donor zones, mark the percutaneous circular blocking recurrent suture relative to the healthy breast in the case of delayed reconstruction and relative to the true spot of the mammary glands in case of correction of tubular deformity, during the operation remove the tissue expander of the reconstructed breast, carry out the tumescent infiltration of donor zones, lipoaspirate is taken in the amount of three volumes of the removed tissue expander, the resulting lipoasprate is centrifuged, subderm is performed real, intramuscular and paracapsular transplantation of the treated adipose tissue in the amount of one and a half volumes of the removed tissue expander, while the main matrix for the transplanted adipose tissue is the capsule of the tissue expander, two-plane liposuction of the skin of the lower one-third of the chest on the reconstruction side is performed using a suture needle, two percutaneous circular recurrent blocking sutures, suture material is carried out subcutaneously parasternally on a segment from the subclavian region to the medial border of the submammary sulcus, in the projection of the marked submammary sulcus, continue intradermally, in the segment from the lateral border of the submammary sulcus to the subclavian region, it is carried out deeply subcutaneously along the mid-axillary line, on the segment the subclavian region to the axillary region, the suture material is carried out subcutaneously and under the lateral edge of the pectoralis major muscle, creating a subdermal and submuscular recurrent component, with fixation points The periosteum of the sternum and the lateral edge of the pectoralis major protrude in the cranial direction, traction of the soft tissues of the lower slope of the reconstructed mammary gland is performed, thereby forming the submammary groove, the external and internal contours of the breast, and the degree of ptosis and the clarity of the topographic landmarks of the reconstructed the mammary gland is regulated by the tightening force of the circular blocking suture, the operation ends with layer-by-layer wound suturing.

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