RU2355331C1 - Submammary fold formation technique - Google Patents

Abstract

FIELD: medicine; oncology.

SUBSTANCE: operation is preceded with marking of prospective submammary fold while the patient is being standing. It is marked 1.5-2 cm higher than the opposite submammary fold. Liposuction area is marked out 2 cm higher and lower the marking line to be performed from two approaches along the edges of formed submammary folds. Fatty tissue is removed including from derma to dense tissues. Then dense subjacent tissues in a projection of submammary fold from several approaches of length 2 cm and less are uncovered including: fascia, periosteum. Skin is fixed to subjacent dense tissues with buried suturing of nonabsorbable suture material. Formation of submammary fold is completed with layered closure of approaches.

EFFECT: method allows recovering shape of reconstructed mammary gland more closely to the natural.

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Description

The present invention relates to medicine, namely to oncology, reconstructive surgery, and can be used in a complex of rehabilitation operations for the reconstruction of the mammary gland.

In the available sources of information, no identical technologies have been identified for the formation of a submammary fold. After breast reconstruction, for example, with a TRAM-flap on the feeding leg (rotational version of the flap) there is no submammary fold, which is destroyed during the operation during the formation of the channel for the flap from the abdomen to the chest wall. The absence of a submammary fold causes the dissatisfaction of the operated patients, as it reduces the naturalness of the reconstructed mammary gland (1, 2, 3).

Based on the existing level of technologies for breast reconstruction, the task was set to ensure restoration of the reconstructed breast form closer to natural.

The problem is solved as follows.

The formation of the submammary fold is carried out as follows: before the operation, the future submammary fold is marked out with the patient standing upright. Then perform maximum liposuction in the marking area. After that, in the projection of the submammar fold from several accesses with a length of not more than 2 cm, dense underlying tissues are exposed (fascia, periosteum) and the skin is fixed to the underlying dense tissues with immersible sutures with non-absorbable suture material. Complete the formation of a submammary fold by layer-by-layer closure of accesses.

Explain the salient features of the proposed method.

Performing maximum “aggressive” liposuction in the marking area allows you to reduce the amount of fatty tissue similar to what it looks like in the place of the natural submammary fold.

Exposure of the dense underlying tissues (fascia, periosteum) in the projection of the submammary fold from several accesses of no more than 2 cm in length and the fixation of the skin to the underlying dense tissues with immersible sutures with non-absorbable suture material ensures the formation of a durable scar, which subsequently creates the naturalness of the formed submammar fold.

The completion of the formation of a submammary fold by layer-by-layer closure of accesses is necessary to give postoperative scars the quality of cosmetic.

The essence of the proposed method of forming a submammar fold is as follows.

The formation of the submammar fold is carried out as follows: before the operation, the future submammar fold is marked up with the patient's vertical position, while marking is performed 1.5-2 cm higher than the opposite submammar fold. 2 cm above and below the line mark the outline of the liposuction zone. Then, on the operating table, the maximum “aggressive” liposuction is performed in the marking area of the curved cannula with a diameter of 3-4 mm. Liposuction is performed from two approaches along the edges of the formed submammar fold and fatty tissue is removed from the dermis to dense tissues (Fig. 1, a). After that, in the projection of the submammar fold from several accesses with a length of not more than 2 cm, dense underlying tissues are exposed (fascia, periosteum) and the skin is fixed to the underlying dense tissues with immersible sutures with non-absorbable suture material (proline 2-3- / 0) (Fig. 1, b ) Complete the formation of a submammary fold by layer-by-layer suturing of accesses (vicryl, monocryl 4/0).

The proposed method is illustrated by drawings, where

 figure 1, a - the implementation of the liposuction stage and marked incisions along the formed submammar folds, b is a diagram of the application of fixing sutures;

 figure 2 - presents photographs of the patient M. after mastectomy of the left breast;

 figure 3 - the state of the left breast of patient M. before the formation of the mammary fold: a - front view, b - side view on the right, c - side view on the left, d - with arms raised up;

 figure 4 - the state of the patient M. after the formation of the submammary fold: a - front view, b - side view on the right, c - side view on the left, d - with hands brought back;

figure 5 - the state of the patient M. after the formation of the nipple-areolar complex: a - front view, b - side view on the right, c - side view on the left.

The essence of the proposed method is represented by a clinical example.

A patient M., born in 1955, was treated in the Irkutsk Regional Oncology Center in 2002 for cancer of the left breast 2 A st., T2N0M0. After the performed mastectomy according to Maden, 4 courses of adjuvant chemotherapy according to CAF were performed (Fig. 2). In 2005, i.e. after 3 years, the patient turned to the Scientific Center for Reconstructive Surgery SB VSNC RAMS with a request to restore the lost breast.

02.15.2005 she underwent delayed plastic surgery of the left mammary gland with a rotational TRAM flap. The postoperative period passed without complications (figa, b, c, d).

The patient did not stop at the stage of acquisition of tissue volume on the left half of the chest. She insisted on several corrective operations. First of all, she was worried about the lack of a submammary fold and the nipple-areolar complex.

September 20, 2005, the formation of a submammar fold was completed by the proposed method.

Before surgery, with the patient's vertical position, the marking of the future submammary fold of the left mammary gland was made 1.5 cm higher than the position of the submammary fold of the right mammary gland. Then, 2 cm above and below the existing marking outlined liposuction zone. The maximum “aggressive” liposuction was performed on the operating table in the marking area from two accesses along the edges of the formed submammary fold of a curved 3 mm cannula with removal of adipose tissue from the dermis to fascia and periosteum. After that, incisions were made in the projection of the submammar fold from several accesses with a length of not more than 2 cm, the fascia and periosteum were exposed, to which the skin was fixed with immersible sutures with non-absorbable suture material - 2-3- / 0 proline. The formation of a submammar fold is completed by layer-by-layer suturing of accesses with vicryl.

The result is stable (figa, b, c, d).

Then, on November 08, 2005, mastopexy on the right by Lezhur was performed. Plastic surgery of the nipple-areolar complex on the left according to Litla (figa, b, c).

The patient is satisfied with the result. Insists on a small correction of the shape of the right gland.

Thus, the proposed method for the formation of a submammary fold in comparison with known technologies makes it possible to restore the shape of the reconstructed mammary gland closer to the natural one.

Sources of information taken into account

1. Schusterman M.A., Kroll S.S., Weldon M.E. Immediate breast reconstruction: why the free TRAM over the conventional TRAM flap? // Plast. Reconstr. Surg. - 1992. - Vol.90, No. 2. - P.255-261.

2. Gherardini G., Arnander C., Gylbert L., Wickman M. Pedicled compared with free transverse rectus abdominis myocutaneous flaps in breast reconstruction // Scand. J. Plast. Reconstr. Surg. Hand. Surg. - 1994. - Vol. 28, No. 1. - P.69-73.

3. Xu X., Maillard G.F. Breast reconstruction by abdominis musculocutaneous flap // Chung. Hua. Wai. Co. Tsa. Chih. - 1995. - Vol. 33, No. 2. - P.117-118.

Claims (1)

A method of forming a submammar fold, characterized in that prior to the operation, the future submammar fold is marked up in the patient’s vertical position, while marking is performed 1.5-2 cm higher than the opposite submammary fold, 2 cm above and below the marking line mark the liposuction zone perform liposuction from two accesses along the edges of the formed submammar fold and remove fatty tissue from the dermis to dense tissues, then in the projection of the submammar fold from several accesses no more than 2 cm long, dense the underlying tissues: fascia, periosteum and fix the skin to the underlying dense tissues with immersible sutures with non-absorbable suture material, complete the formation of a submammal fold by layerwise suturing of accesses.

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