RU2810449C1 - Method of performing surgical operation to eliminate gynecomastia with skin ptosis of iii, iv degree - Google Patents

Abstract

FIELD: medicine; plastic surgery.

SUBSTANCE: skin markings are applied to the patient's chest area in a standing position. Then deep-epidermization in the area of the para-areolar ring is performed, surgical access is provided by resection of the skin removing hypertrophied mammary glands and excess adipose tissue through surgical access, followed by hemostasis and suturing of the wound. At the same time, at the level of the IV intercostal space along the midclavicular line, an oval of 2×1 cm is noted which is the future location of the areola. The skin at the site of the future location of the areola is excised to its full thickness. A line is drawn 2–3 cm below the oval, connecting to the medial and lateral edges of the inframammary fold, an incision is made along the previously drawn lines, the nipple-areolar complex on the medial pedicle is moved to the prepared place and fixed.

EFFECT: method allows to reduce the risk of necrosis of the nipple-areolar complex, significantly reduce the duration of the rehabilitation period, prevent postoperative complications while achieving a good cosmetic effect.

1 cl, 5 dwg, 1 ex

Description

The invention relates to medicine, namely to surgery, and can be used in plastic surgery.

There is a previously described endoscopic method for the treatment of benign neoplasms of the mammary glands in men (RF patent No. 2393784, A 61 B 17/00, A 61 B 17/02, Bulletin No. 19, 07/10/2010), including the creation of a tunnel to the tumor through the subaxillary access using an endoretractor with an endoscope inserted into it. The working cavity is formed by gas insufflation, after which the nipple is separated and the central milk duct is crossed, preserving the circular smooth muscle fibers as part of the areolar complex. The mammary gland capsule is isolated from the surrounding tissue, the edges of the tumor are released, and its removal is performed by aspiration.

However, this method has the following disadvantages: it is impossible to remove excess skin and subcutaneous fat in case of ptosis of the nipple-areolar complex III and IV, which leads to an unsatisfactory aesthetic result.

The closest to the proposed method is a method of performing a surgical operation to eliminate gynecomastia (RF patent No. 2588487, A 61 B 17/00, Bulletin No. 18, 07/27/2016), including applying skin markings with a vertical median to the chest area of the patient in a standing position -sternal line and para-areolar ring formed by an internal circular line within the areola and a concentric external circular line. Next, deep-epidermization is performed in the area of the paraareolar ring. Then the hypertrophied mammary glands and excess adipose tissue are removed through the same surgical approach, followed by hemostasis. Suturing the wound differs in that a marking angle is additionally applied to the chest area, for which a perpendicular to the anterior axillary line of the chest is drawn in the direction from the nipple and tangents are drawn from the point of their intersection to the outer circular line so as to cover from 1/3 to 1/2 its circle, with the vertex of the angle at the mentioned point of intersection. As a result, 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 liposuction of excess fatty tissue is performed through this access.

However, this method has the following disadvantages: with grade 3-4 skin ptosis, it is impossible to move the nipple-areolar complex high and remove excess skin medial to the nipple-areolar complex to achieve a cosmetic effect.

The objective of the proposed method is to: take into account the degree of ptosis of the skin of the mammary glands at grade 3-4, remove excess fat and glandular tissue, excess skin to achieve a cosmetic effect, reduce the risk of necrosis of the nipple-areolar complex, reduce the risk of long-term postoperative complications, speed up the healing process of postoperative wounds and reduce rehabilitation time.

The task is carried out due to the fact that the nipple-areolar complex is moved subcutaneously on the medial leg, to an anatomically correct position in a previously prepared place (a section of excised skin in the IV m/r along the midclavicular line, 2-3 cm above the inframammary fold, size 2 × 1 cm in the form of an oval); removal of excess skin is carried out from the original submammary fold to the future new submammary fold.

The method is carried out as follows: Before the operation, markings are applied: the submammary fold and the midclavicular line are outlined. At the level of the IV intercostal space along the midclavicular line, an oval of 2x1 cm is marked - the future location of the areola. A line is drawn 2-3 cm below this oval, connecting to the medial and lateral edges of the inframammary fold. After marking, an incision is made in the operating room along the previously drawn lines. The skin at the site of the future location of the areola is excised to its full thickness. The medial feeding pedicle of the nipple-areolar complex is formed, followed by de-epidermization of the pedicle. The SAH is transferred subcutaneously on the medial pedicle to a new position and fixed with absorbable monofilament sutures 3/0 and 4/0. Using a radio wave knife, excess skin, glandular and fatty tissue is removed between previously made converging incisions while preserving the medial pedicle. The postoperative wound is sutured with absorbable monofilament sutures 3/0 and 4/0 to form a new submammary fold. Ac. bandage.

Clinical example of using the proposed method : Patient N. was admitted with complaints of sagging breast skin and psychological discomfort when wearing clothes. Upon examination, a low location of the SAH is noted; on the right, the areola is directed downward, which corresponds to degree IV ptosis (Fig. 1). An operation is planned - removal of the mammary gland, correction of the location of the areola, excision of excess skin. The surgical field was marked (Fig. 2).

Operation: after treatment of the surgical field under general anesthesia, de-epidermization of the nipple-areolar complexes was performed from 12 o'clock to 3 o'clock on the right, from 12 o'clock to 9 o'clock on the left. The latter are fixed on the medial leg, the skin is excised from the inframammary fold to the upper edge of the areola, preserving the medial leg. The breast gland and excess fat tissue are excised. 2.5 cm above the upper incision line along the midclavicular line, a 2 × 1 cm window was prepared for the nipple-areolar complex, the latter was moved and fixed (Fig. 3). The wound was sutured with absorbable monofilament sutures 3/0 and 4/0. Ac. bandage.

When examining the patient after 12 hours: SAH is pink, without signs of ischemia (Fig. 4).

After 10 days: the wound heals by primary intention. The patient has no complaints (Fig. 5).

The technical result of the method is: an individual approach taking into account the anatomical and functional ptosis of the mammary glands, the risk of necrosis of the nipple-areolar complex is reduced, the duration of the rehabilitation period is significantly reduced, there are no postoperative complications, and a cosmetic effect is achieved.

Claims (1)

A method of performing a surgical operation to eliminate gynecomastia with grade III, IV ptosis, including applying skin markings to the chest area of the patient in a standing position; de-epidermization in the area of the para-areolar ring, performing surgical access by resection of the skin, removing hypertrophied mammary glands and excess adipose tissue through surgical access, followed by hemostasis and suturing of the wound, characterized in that at the level of the IV intercostal space along the midclavicular line a 2 × 1 oval is noted cm - the future location of the areola, the skin at the site of the future location of the areola is excised to its full thickness, a line is drawn 2-3 cm below the oval, connecting to the medial and lateral edges of the inframammary fold, an incision is made along the previously drawn lines, the nipple-areolar complex is on the medial the leg is moved to the prepared place and fixed.