RU2628238C1 - Method for mammoplasty - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: mammary gland (MG) plasty with high ptosis or a stretched "dermal sheath" is performed. At that, Botox is injected into the large pectoral muscle 8-10 days before the operation and into the cavity in the large pectoral muscle base during the operation, prior to implant insertion. During the operation, the MG skin within the operating field is shrunk by exposure to laser radiation or ultrasound. Fibrin glue mixed with a solution of a nonpolarizing muscle relaxant is used, and the cavity is washed with an antibiotic solution before drying.

EFFECT: method has a high aesthetic effect, ensures the stability of the mammary gland with the necessary shape, minimizes ptosis, excludes scars on the incision site.

3 cl, 14 dwg, 3 tbl, 3 ex

Description

The invention relates to aesthetic medicine, and more specifically to plastic surgery, and is intended to correct the shape of the mammary gland.

There is a known method of mastopexy, in which the areola is separated by a circular incision, a second circular incision and excision of the breast skin (MF) are performed at the new location of the areola, the excess skin and tissues are excised, an access cavity is formed and a polypropylene mesh is placed in it in the form of a “hammock” which is fixed at the necessary points that ensure the formation of the MF with a sewn-in “hammock”. [one]

The disadvantage of this method is the high degree of formation of postoperative scars around the perimeter of the areola, which, of course, reduces the aesthetic effect of plastic surgery and, in addition, the introduction of a polypropylene mesh introduces the risk of prolapse of the walls of the access cavity with the ensuing consequences.

Closest to the claimed invention in its technical essence and the achieved technical result is a method of breast plastic surgery, including an incision of the skin along the areola, penetration through the incision into the retro-mammary space and the formation of a cavity under the implant by expanding the tissues, draining the cavity, introducing fibrin glue into it, followed by the implant cavity, giving the MF a given shape, fixing it and suturing and gluing the incision. [2]

The specified prototype represents a fundamental solution to the problem within the scope of the task posed and implemented in this invention, namely, “designing” and maintaining the shape of the designed MF. At the same time, it is known that the human body, and, in particular, such a delicate formation as the mammary gland, in our case, considered not from a biofunctional, but an aesthetic point of view, in reality is quite diverse in topographic and geometric parameters. Therefore, with breast plastic surgery with ptosis of at least the second (and even third) degree or an extended “skin cover” according to this prototype it is very difficult, and it is even impossible to achieve the formation and preservation of the desired form of the breast, which is explained by the presence of excess stretched skin.

In addition, another disadvantage of this prototype (as well as other methods of breast plastic surgery involving surgical intervention) is the long-term postoperative rehabilitation (hospitalization or outpatient monitoring), and the long-term discomfort caused by pain, local inflammatory processes, etc. .P. phenomena.

The technical result, the achievement of which the creation of this invention is directed, is to achieve a high and long-lasting cosmetic effect, by giving the mammary gland a stable aesthetically sustained shape, eliminating ptosis (or stretched "skin cover"), eliminating the appearance of a scar at the site of the incision, and also reducing the time of postoperative rehabilitation (hospitalization or outpatient monitoring), and minimizing or eliminating postoperative pain and local inflammations s processes.

The stated technical result is achieved by the fact that with breast plastic surgery with ptosis or a stretched “skin cover” including an incision of the skin along the areola, penetration through the incision into the retro-mammary space, the formation of a cavity under the implant by spreading tissue, draining the cavity, introducing fibrin glue into it, placing it in the formed the implant cavity, followed by giving the MF the desired shape, fixing it, suturing and gluing the incision, 12-14 days before surgery in the pectoralis major muscle, Botox is introduced into 20 = 30 units. on one muscle, at the beginning of the operation, the skin of the breast within the surgical field is seated by the action of laser radiation or ultrasound, before placing the implant in the cavity in the base of the pectoralis major muscle and along with its fibers, re-inject Botox at the rate of 20-30 units. on the muscle, then the implant is placed in a cavity previously washed with an antibiotic solution, then fibrin glue is mixed with a solution of long-acting non-polarizing peripheral muscle relaxant, and antibiotics from the aminoglycoside group are used as antibiotic, and depending on the size of the breast and its skin condition seated with laser radiation with a power of 6-12 mW for 5-20 minutes or exposure to ultrasound with a power of 10-20 mW for 5-20 minutes.

During breast surgery with ptosis or an extended “skin cover”, the volume (depending on the desired size of the breast) may not particularly change, and the surface area of the skin of the breast may and should most often decrease (in practice, about 1.2-1.7 times) . The epidermis, dermis and hypodermis, of course, have elasticity along with, of course, high relaxation ability under mechanical stretching, however, these skin properties have their limits in quantitative terms and significantly depend on many factors - patient age, general condition of the body, etc. Therefore, for successful operation on the "reconstruction" of the breast, there is a need to somehow reduce the excess skin except, however, excision of it. In the present technical solution, this effect can unexpectedly be solved by sitting (contracting) the skin under the influence of laser radiation or ultrasound directly during the operation.

As the implant, silicone shell implants are used, for example, Mentor, Natrelle, etc.

As a suture material, absorbable sutures are used, for example, Vikril, Polysorb and other surgical sutures similar in functional characteristics.

For example, Tissucol Kit et al. Are used as fibrin glue, however, it is preferable to use fibrin glue from the patient’s own blood (autologous), since in this case the biochemical processes in the cavity during implantation will be accompanied with a minimum of complications.

Autologous fibrin glue can be obtained using the CRYOSIL FS mini-laboratory, which can automatically prepare fibrin glue. In the claimed technical solution, the author uses the aforementioned mini-laboratory to obtain fibrin glue from the autologous blood of patients.

As strips, a surgical patch is used, for example, Steri-Strip, etc.

As Botox, for example, Relatox (botulinum toxin type A in combination with hemagglutinin), Xeomine, Lantox, and other Botox analogues are used.

Long-acting peripheral muscle relaxants are used as a non-polarizing muscle relaxant, for example, arduan, melliktin, diplacin.

Aminoglycosides, for example gentamicin, monomycin, neomycin and other similar antibiotics, are used as an antibiotic to flush the cavity under the implant.

Body temperature is monitored by mercury maximum or digital (with memory) thermometers. The body temperature of the near-surgical area is monitored, for example, with a Medisana FTN IR thermometer or a FLUKE 570 series pyrometer.

ESR monitoring is carried out by the ESR meter PR-3.

Of course, laser skin sitting (like ultrasound) is carried out taking into account possible contraindications (malignant neoplasms, blood diseases, disorders of the blood coagulation system, decompensated cardiovascular diseases, etc.).

For sitting (contraction) of the skin can be used, for example, lasers LG-75-1, LGN-111, ULF-01 with continuous operation, or AFL-2, AFDL-1 with continuous-pulse operation, etc. He- Ne lasers with a wavelength of 1064-1150 nm and a low adjustable output power (not more than 25 mW).

Ultrasonic sitting (contraction) of the skin is carried out, for example, using the SONOCA lipo ultrasonic liposuction apparatus (ultrasound frequency 25 kHz, adjustable output power up to 60 mW).

The remaining materials and devices necessary and used in the implementation of the proposed technical solution, as well as the technical methods used in the implementation of this method, will be mentioned in detail and described in the examples of specific implementation of the invention.

The invention can be implemented as follows.

Initially, Botox is injected into the pectoralis major muscle 12-14 days before surgery. Then, in the process of preoperative preparation, the parameters of the breast are measured and the field of the future operation is marked. At the beginning of the operation, the skin of the breast within the surgical field is seated by the action of laser radiation or ultrasound, then an incision is made of the skin along the lower half of the areola circumference without going beyond its borders, and a blunt surgical instrument forms a cavity under the implant by “pushing” the space between the chest and muscle fascia or between pectoral muscles. Then, the cavity thus formed is washed with an antibiotic solution and, at the same time, Botox injection is repeated in the base of the pectoralis major and minor muscle. The cavity is drained and the implant is placed in it and then fibrin glue is mixed (injected) into it with a non-polarizing muscle relaxant, hands give the MF the desired shape (the glue is evenly distributed over the walls of the cavity) and held in this state until the glue has completely set (usually enough 2 ÷ 4 min), then a deep dermal suture with absorbable suture is performed on the incision, and the upper layer of the epidermis is pushed apart and the resulting gap is filled with fibrin glue, butt joints are closed and fixed with a strip with the last yuschim superposition of dry dressings.

Quantitative indicators of injections, the ratio of components in the used mixtures of drugs, etc. data will be presented in specific embodiments of the claimed invention.

Note 1: For ethical and technical reasons, the implementation of the invention is carried out on volunteers after agreement with the ethics committee.

Example 1

Patient K ***, 37 years old. Volunteer. I agreed to the breast recovery operation. The initial state of the patient’s MF is presented in Photo 1.

MF characteristics: skin is thin, elasticity is reduced, striae are insignificant, breast size C, areola diameter 5.0 cm, ptosis degree 2, the cause of ptosis is deformation of the MF under the influence of soft touch gel (loss of shape “memory”), asymmetries of the nipple-areolar complex (SAC).

Proposed: ptosis correction, shape restoration.

13 days before the operation, the patient is injected with Botox Relatox at the rate of 25 units in the pectoralis major muscle. into every muscle. In the process of performing the operation, the operational field is preliminarily marked. The operation is performed under general anesthesia. In accordance with the marking (see photo 2), a skin incision is made along the outer lower border of the areola. The length of the incision is 6.0 cm. Penetrate through the incision into the retro-mammary space and the spilled silicone filler is pumped out of it. Then the skin of the breast is seated by irradiation with an AFDL-1 laser in a pulsed mode of operation at a radiation power of 11 W; exposure time 17 min. In the near-aolar space, the skin is pierced with a needle (gauge 18), inserted under the skin, and the optical fiber is moved back and forth. The process of laser skin sitting is shown in Photo 3. The sitting topography is shown in FIG. 1. Next, the cavity under the implant is restored - a pocket 11.5 wide and 12.0 cm high. Then, the restored cavity is washed with an antibiotic solution (a solution of 1 mg of gentamicin / 50 ml of physiological solution of 0.9% sodium chloride is used as an antibiotic). At the base of the pectoralis major muscle and along its fibers, Botox is injected at the rate of 25.0 units. Next, the cavity is drained, an implant is placed in it (Natrelle FM, 270 ml, profile 2.5 cm, width 11.5 cm, height 12.0 cm) and fibrin glue is introduced (11 ml mixed with 100 mg of mellitin), put on with your hands MF is given the desired shape and kept in this state for 2.5 minutes until the glue has completely set (the cool mix is evenly distributed over the cavity walls). After that, the incision is sutured with a deep dermal suture with an absorbable thread (Vicril 4-0), while the stitch length is 5, 0 mm Then the upper layer of the epidermis is pushed apart in an incision, smeared with a glue, slit the edges of the slit butt and fixed with a Steri-Strip. At the end of the operation, a dry dressing is applied to the operated MF.

The postoperative condition of the patient (control of body temperature and area of operation, ESR) is presented in Table 1.

The rehabilitation period after the operation took 4 days - 1 day in the hospital and 3 days outpatient monitoring (the patient was in the hospital without restricting activities). Sutures were removed on the 8th day. Compression underwear is used within 12 days after surgery. The rehabilitation period was practically not accompanied by pain and swelling.

The postoperative condition of the breast is shown in Photo 4 (30th day). Swelling is absent, the healing in the area of skin adhesion is primary, complete. The patient's health is comfortable. There is a slight elongation of the skin cover in the lower part of the breast. The postoperative condition of the patient’s breast cancer after 6 months is shown in Photo 5 - there are no scars and scars, there is no stretched skin cover, the degree of correction is complete with a pronounced cosmetic effect.

Example 2

Patient 3 ***, 32 years old. Volunteer. I agreed to the breast recovery operation. The initial state of the patient’s MF is presented in Photo 6.

MF characteristics: skin is thin, elasticity is reduced, striae are present, breast size C, areola diameter 6.0 cm, 2nd ptosis degree, “skin cover” is stretched, asymmetry of the nipple-areolar complex (NAO) is present.

Proposed: ptosis correction, shape restoration.

The operation is carried out as in Example 1, except that 14 days before the operation, the patient is injected with Botox at the rate of 27 units / muscle in the pectoralis major muscle. The marking of the surgical field is shown in Photo 7. The operation is performed under general anesthesia. The skin is seated with ultrasound irradiation (SONOCA lipo ultrasonic liposuction apparatus, ultrasound frequency 25 kHz, power 28-30 mW, irradiation time 18 min). The skin sitting process is carried out according to the scheme shown in FIG. 1. Next, a cavity is formed under the implant by “pushing” the space between the pectoral muscles — a pocket 12.0 cm wide and 12.5 cm high is formed. Then the cavity thus formed is washed with an antibiotic solution (a solution of 1 mg gentamicin / 50 ml physiological solution is used as an antibiotic 0.9% sodium chloride). At the base of the pectoralis major muscle and along its fibers, Botox is injected at the rate of 23.0 units. Then the cavity is drained, an implant is placed in it (Natrelle FM, 270 ml, profile 5.0 cm, width 10.5 cm, height 11.0 cm) and fibrin glue is introduced (12 ml mixed with 100 mg of diplacin), put on with your hands MF is given a predetermined shape and is kept in this state for 3.5 minutes until the glue is completely set (at the same time, the cool mixture is distributed evenly over the cavity walls). After that, the incision is sutured with a deep dermal suture with an absorbable thread (Vicril 4-0), with a stitch length of 5.0 mm . Then the upper layer of the epidermis is pushed apart in an incision, smeared with a glue, slit the edges of the slit butt and fixed with a Steri-Strip. At the end of the operation, a dry dressing is applied to the operated MF.

The postoperative condition of the patient (control of body temperature and area of operation, ESR) is presented in Table 2.

The postoperative condition of the breast is shown in Photo 8 (21st day). Healing in the area of skin adhesion is complete. The patient's health is comfortable. Photo 9 shows the postoperative condition of the breast (6 months) - there are no scars and scars, the degree of correction is complete with a pronounced cosmetic effect.

Example 3

Patient B ***, 28 years old. Volunteer. I agreed to the breast recovery operation. The initial state of the patient’s MF is presented in Photo 10.

MF characteristics: skin is thin, elasticity is reduced, striae are absent, breast size B, areola diameter 5.0 cm, ptosis degree 2, “skin cover” is stretched, asymmetry (vertical ovality, 2/3) of the nipple-areola occurs complex (SAK).

Proposed endoprosthetics of the breast.

The marking of the surgical field is shown in photo 11. The operation is carried out as in Example 1, except that the physical parameters of the incision (4.0 cm), the formed pocket (cavity depth 7 cm, width 10 cm and height 12.5 cm) are changed, a Natrelle FM implant is installed, 235 ml (profile 4.0 cm, width 10.0 cm, height 11.5 cm). The notch is sutured with Vicril 4-0 thread, with a stitch length of 5.0 mm. At the request of the patient, Tissucol Kit fibrin glue is used. Skin sitting is carried out by laser irradiation according to the scheme shown in FIG. 1. The exposure time of 23 minutes, the radiation power of 14 mW.

The postoperative condition of the patient (control of body temperature and area of operation, ESR) is presented in Table 3.

The postoperative condition (day 21) is shown in photo 12 - there is no swelling, healing in the area of bonding of the skin of the areola is complete. The postoperative condition of the breast after 6 months. presented in Photo 13.

The author notes that sitting (contraction) of the skin of the breast after training with a laser or ultrasound during the operation occurs spontaneously for 4-6 months.

For ethical reasons, the author does not present comparative examples and considers a link to an Internet resource sufficient:

“The rehabilitation period after breast lift takes about a week. 1-2 days will need to be spent in a hospital (in the case of general anesthesia), after which it is advisable to minimize activity for a few more days. Sutures are removed on the 10-14th day. For 2-3 weeks after the operation, wearing compression underwear is mandatory. In addition, in the next month, in no case should you lift weights and play sports. During the rehabilitation period, pain and swelling are possible, which will gradually disappear. In a small percentage of patients there is also a permanent decrease, or vice versa - an increase in the sensitivity of the nipples. The final result can be evaluated no earlier than 3-4 months after mastopexy. ” (www.tecrussia.ru/plastia/42-podtyazhka-grudi.html)

As can be seen from the examples of the method, confirmed by illustrative material, the claimed invention provides: a high aesthetic and long-lasting cosmetic effect, eliminates the appearance of a scar at the incision site, as well as reduces the time of postoperative rehabilitation (hospitalization or outpatient monitoring), and minimizes or eliminates postoperative pain, the manifestation of local inflammatory processes and postoperative discomfort.

Information sources

1. RU 2313287 C1, M. cl. A61B 17/00, 12/27/2007.

2. RU 2521346 C1, M. cl. A61B 17/00, 12/27/2014 - prototype.

Claims (5)

1. The method of breast plastic surgery (MF), including an incision of the skin along the areola, penetration through the incision into the retromammary space, the formation of a cavity under the implant by expanding the tissues, draining the cavity, introducing fibrin glue into it, placing the implant in the formed cavity, followed by giving the MF the desired shape , fixing it, suturing and gluing an incision, characterized in that when plastic breast with ptosis or stretched "skin cover" 12-14 days before surgery in the pectoralis major muscle carry out the introduction of Botox dosage of 20 = 30 units. on one muscle, at the beginning of the operation, the skin of the breast within the surgical field is seated by the action of laser radiation or ultrasound, before placing the implant in the cavity in the base of the pectoralis major muscle and along with its fibers, re-inject Botox at the rate of 20-30 units. on the muscle, then the implant is placed in a cavity previously washed with an antibiotic solution, then fibrin glue is mixed with a solution of an underpolarizing muscle relaxant, 2. The method of breast plastic surgery according to claim 1, characterized in that long-acting peripheral muscle relaxants are used as non-polarizing muscle relaxant. 3. The method of breast plastic surgery according to claim 1, characterized in that antibiotics from the group of aminoglycosides are used as an antibiotic. 4. The method of breast plastic surgery according to claim 1, characterized in that, depending on the size of the breast and the condition of the skin, the latter is seated with laser radiation with a power of 6-12 mW for 5-20 minutes. 5. The method of breast plastic surgery according to claim 1, characterized in that, depending on the size of the breast and the condition of the skin, the latter is seated with ultrasound of 10-20 mW for 5-20 minutes.

Images