RU2494687C1 - Method of correcting shape of tubular breasts - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular, to methods of plastic surgery. Radial dissections of fibrous ring in mammary gland tissue are made from the inside in suprafascial space, without separation of glandular tissue from skin on conventional clock face from 2 to 10 o'clock.

EFFECT: method reduces trauma and simplifies technique of carrying out correction of breast shape.

3 ex, 2 dwg

Description

FIELD OF THE INVENTION

The invention relates to medicine, in particular, to a method for correcting the shape of a tubular breast and can be used for surgical intervention on the mammary gland in plastic surgery.

State of the art

A known implant for maintaining the mammary gland, the essence of the location of which is as follows: a cut along the submammary fold dissects the skin and subcutaneous fat, then a cutaneous-subcutaneous - fat flap of the lower quadrants of the mammary gland is bluntly and sharply mobilized, and thus a bed for implantation is created of the implant, the next stage is the location of the implant: the support plate is adjacent to the chest wall, and the protrusions located at an angle cover the mammary gland along its contour and, taking on the weight of the mammary gland the glands interfere with its prolapse; later, the holes of the support plate sprout out with tissue, which prevents it - the plate - sliding along the chest wall, and a sufficiently pronounced subcutaneous fat of the mammary gland, which is its characteristic feature, does not allow to distinguish the implant from the outside (see Pat . RU No. 2332188, IPC A61F 2/12, published on August 27, 2008).

The disadvantage of this method of placement of the implant is high invasiveness.

A known method of plastic surgery of the mammary gland with an anomaly in the development of the mammary gland, known as the tubular breast, with the third type of tubularity according to the classification of J. Grollean (see Breast base anomalies: treatment strategy for tuberous breast, minor deformities and asymmetry / J. Grollean, E. Lanfrey, B. Lavigne // Plast. Reconstr. Surg. - 1999. - Vol.104, No. 7. - P.2040-2048), consisting in hypoplasia of all four breast quadrants in all patients, endoprosthetics combined with surgery C. Puckett, M. Concannon or according to A. Mandrekas, the feature of this method is the release of the lower hemisphere of the pier of the full gland from the skin covering it, followed by dissection from the inside of the fibrous adhesions on the mammary gland and further covering the lower part of the endoprosthesis with a flap of the mammary gland (see Augmentation the narrow - based breast: the unfurling technique to prevent the double - babble deformity / C. Puckett, M Concannon // Aest Plast. Surg. - 1990. - Vol. 14, No. 1. - P.15-19 Aesthetic reconstruction of the tuberous breast deformity / A. Mandrekas, G. Zambacos, A. Anastasopoulos, D. Hapsas et. al // Plast. Reconstr. Surg. - 2003. - Vol. 112, No. 4. - P.1099-1108).

The disadvantage of this method of surgical treatment is the high morbidity and complexity of the manipulations, since it is necessary to mobilize the mammary gland below the nipple-areolar complex almost completely.

The closest in technical essence and the achieved positive effect and adopted by the author for the prototype is a method for correcting the shape of the tubular breast according to A. Mandrekas, in combination with endoprosthetics, in which, after a circummolar incision, the glandular tissue is separated from the skin to the level of a new inframammary fold, then milk is mobilized the gland along the posterior surface in the proximal direction to the upper hemisphere, then the mammary gland is brought into the wound in the lateral and medial directions, dissect the fibrous connective tissue fibers of the fibrous ring are dissected in the breast tissue according to the conditional dial from 2 to 10 hours, that is, in the breast along the vertical axis downward, along the back surface of each half of the dissected gland, as a result, the gland tissue becomes plastic, then an endoprosthesis is installed , both halves of the gland are sutured together with the formation of a glandular “apron”, which covers the endoprosthesis, the distal edge of the “apron” is fixed with separate percutaneous sutures at the level of the submammary fold and the wound it is sutured with a zirmumareolar suture, so the method involves performing a periareolar skin incision half the areola circumference, mobilizing breast tissue along the front and back surfaces of the lower hemisphere of the breast from the nipple level to the submammary fold, removing the breast into the wound, dissecting the fibrous ring in the tissue breast on the back surface according to the conditional dial from 2 to 10 hours, the formation of the pocket for the implant is partially in the axillary space with a further covering of the jelly implant s "apron" mammary gland and fixation of the distal edge to submammary folds (cm. Aesthetic breast surgery, a guide for doctors, S.P. Galich, V.D. Pinchuk, Kiev, 2009, p. 257-268).

The disadvantage of this method of correction of the tubular breast is the high morbidity and the complexity of the method.

Disclosure of invention

The objective of the invention is to develop a method for correcting the shape of the tubular breast with a decrease in morbidity and simplification of the method of performing the operation.

The technical result, which can be obtained using the present invention, is to reduce the morbidity and simplify the way the operation is performed.

The technical result is achieved using a method for correcting the shape of the tubular breast, including performing a periareolar incision of the skin on the breast tissue at half the circumference of the areola, radial dissection of the fibrous ring in the breast tissue according to the conditional dial from 2 to 10 hours, forming a pocket for the implant in the axillary space wherein, the dissection of the breast tissue is performed vertically down to the fascia of the pectoralis major muscle, dissection in an acute and blunt way in the supra-fascial plane is performed from the level of the nipple and to the submammary fold, and the dissection of the fibrous ring in the breast tissue is carried out, from the inside, without detaching the glandular tissue from the skin.

The essence of the proposed method for correcting the shape of the tubular breast is as follows.

The operation is carried out as follows, after performing a periareolar incision of the skin 1 on the mammary gland tissue 2 (not indicated in FIG.) By half the circumference of the areola, the mammary gland tissue 2 is cut vertically down to the fascia of the pectoralis major muscle 3, in the supra-fascial plane from the level of the nipple (not indicated in Fig.) and until submammary fold 4, dissection is carried out in an acute and blunt way, then radial dissection of the fibrous ring 5 in the tissue of the mammary gland is performed according to the conditional dial from 2 to 10 hours, control Sectional dimensions are determined by palpation until the required plasticity of tissues 1, mammary gland is achieved, then a pocket (Fig. not indicated) is formed for the implant 6 in the axillary space (not indicated in Fig.), moreover, radial sections 7 of the fibrous ring 5 in the mammary tissue 2 spend, from the inside, without detachment of glandular tissue from the skin, after the location of the implant 6 in a pocket in the axillary space, suture 8 wounds.

Brief Description of the Drawings

Figure 1, is given a method of correcting the shape of the tubular breast, access, side view.

In figure 2, the same operation of the correction of the shape of the tubular breast is completed.

Figure 3, the same, bottom view.

Figure 4, the same, straight view.

The implementation of the invention

Examples of specific performance of the method of correction of the shape of the tubular breast.

Example 1. Patient M., 20 years old, medical history No. 147, was admitted to a short-term hospital with complaints about the small size of the mammary glands, examination revealed a tubular breast, the third type of tubularity according to J. Grollean classification, the operation is carried out according to the form correction method tubular breast according to A. Mandrekas, in combination with endoprosthetics, (see Aesthetic breast surgery, a guide for doctors, S.P. Galich, V.D. Pinchuk, Kiev, 2009, p. 257-268), that is, accepted decision to perform augmentation mammoplasty with simultaneous correction by mammary glandular tubularity, circumpolar access was performed on the right mammary gland by periareolar incision of skin 1 on breast tissue 2 (not indicated in FIG.) by half the circumference of the areola, while the glandular tissue was separated from the skin to the level of a new submammar fold 4 then they mobilize the mammary gland along the posterior surface in the proximal direction to the upper hemisphere, then the mammary gland displays the wound in the lateral and medial directions, while along the posterior surface of each of the halves dissected mammary gland dissected connective tissue cords of the fibrous ring 5, then form a pocket (in FIG. not indicated) for the implant 6 in the partially axillary space (not indicated in FIG.), both halves of the mammary gland are sutured together to form a glandular “apron” (not shown in FIG.), which cover the implant 6, the distal edge of the “apron” is fixed separate percutaneous sutures 8 at the level of the submammary fold 4 and the wound is sutured with a cirmumareolar suture 8. A similar operation is performed on the left mammary gland. The duration of the operation is 2 hours. 50 minutes

Result: the diagnosis was a tubular breast, the postoperative period was satisfactory, the patient was discharged on the 3rd day after the operation, the sutures on the submammary fold were removed on the 6th day.

Example 2. Patient K., 25 years old, medical history No. 174, was admitted to a short-term hospital with complaints about the small size of the mammary glands, upon examination revealed a tubular breast, the third type of tubularity according to J. Grollean classification. a decision was made to perform augmentation mammoplasty with simultaneous correction of mammary tubularity. On the right mammary gland after performing a periareolar incision of the skin 1 on the mammary gland tissue 2 (not indicated in FIG.) By half the circumference of the areola, the mammary gland tissue 2 is cut vertically down to the fascia pectoralis muscle 3, in the supra-fascial plane from the level of the nipple ( in Fig. is not indicated) and to the submammary fold 4, dissections are carried out in an acute and blunt way, then five radial dissections of the fibrous ring 5 in the tissue 1 of the mammary gland are performed according to the conditional dial from 2 to 10 hours, control of the sufficiency of the sections are determined by palpation until the required plasticity of the tissues of the mammary gland 2 is reached, then a pocket (Fig. not indicated) is formed for the implant 6 partially in the axillary space (not shown in Fig.), and radial dissections of the fibrous ring 5 in the mammary tissue 2 are carried out , from the inside, without detachment of glandular tissue from the skin, after placing the implant 6 in a pocket in the armpit, make a suture 8 of the wound. A similar operation is performed on the left mammary gland. The duration of the operation is 1 hour 15 minutes.

Result: the diagnosis was tubular breast, the postoperative period was satisfactory, the patient was discharged the day after surgery.

Example 3. Patient P., 23 years old, medical history No. 193, was admitted to a short-term hospital with complaints about the small size of the mammary glands, examination revealed hypoplasia of all four quadrants of the mammary glands, which is defined as tubular breast, type III tubularity according to classification J Grollean. The patient was asked to perform augmentation mammoplasty with simultaneous correction of the mammary glandular tubularity, on the right mammary gland after performing a periareolar skin incision 1 on the mammary gland tissue 2 (not indicated in Fig.) By half the areola circumference from 3 to 9 hours of the conditional dial, dissecting the tissue 2 of the mammary gland vertically down to the fascia of the pectoralis major muscle 3, in the supra-fascial plane from the level of the nipple (not shown in Fig.) And to the submammary fold 4, dissections are performed in an acute and blunt way, then perform five radial dissections of the 7 fibrous ring 5 in the tissue of the 1-mammary gland according to the conditional dial from 2 to 10 hours, the control of the sufficiency of the dissection is determined by palpation until the required plasticity of the tissues of the 1 mammary gland is achieved, then a pocket is formed (not indicated in Fig.) for the implant 6 in the axillary space (not indicated in Fig.), And the projection 7 of the dissection of the fibrous ring 5 in the tissue V of the mammary gland is radial, from the inside, without detaching the glandular tissue from the skin, after the implant is located 6 in a pocket in the armpit, stitch 8 wounds. A similar operation is performed on the left mammary gland. The duration of the operation is 1 hour 10 minutes.

Result: the diagnosis was tubular breast, the postoperative period was satisfactory, the patient was discharged the day after surgery.

Thus, the operation according to the invention according to examples 2 and 3 is the most optimal, as a result of which the operation according to this method allowed to reduce the length of the incision, reduce the invasiveness of the intervention and the duration of the operation.

The invention in comparison with the prototype and other known technical solutions has the following advantages:

- reducing the morbidity of breast surgery;

- reducing the length of the cut;

- reduction of operation time;

- simplification of the method of performing the operation.

Claims (1)

A method for correcting the shape of the tubular breast, including performing a periareolar incision of the skin on the breast tissue at half the circumference of the areola, radial dissection of the fibrous ring in the breast tissue according to the conditional dial from 2 to 10 hours, forming a pocket for the implant in the axillary space, characterized in that Breast tissue dissection is performed along the vertical axis down to the fascia of the pectoralis major muscle, then the mammary gland is mobilized along the posterior surface from the level of the nipple to the submammary fold And anulus dissection in breast tissue is carried out inside, without detachment from glandular tissue of the skin.

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