RU2844727C1 - Method of surgical treatment of macromastia associated with benign mammary dysplasia - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to plastic surgery and obstetrics and gynaecology. Operation is preceded by breast ultrasonography and mammography, and incisions are made along the marking lines. That is followed by de-epidermisation of the dermoglandular leg along the marking lines, further transecting the breast tissue to the fascia of the greater pectoral muscle and a lower vascular glandular leg is formed with side flaps of a triangular shape, on base of 8 cm wide, portions of fibrous and cystic changed mammary gland tissues are removed. Bed is formed for the movable free edge of the glandular crus in projection of 2^nd-3^rd intercostal space. Further, the free edge of the glandular leg is fixed to the fascia of the greater pectoral muscle (MBM) at level of 2^nd rib with non-absorbable sutures, the side triangular flaps of the formed dermoglandular leg are turned upwards and the upper edges of the flap are anchored to the free edge of the glandular crus dermo-dermally, and the lower edges of the flap to the fascia of the BGM with a continuous suture; dermal-fat flaps are mobilized towards a mammary gland, covered and sutured on subcutaneous fat and skin.

EFFECT: method allows to remove sections of fibrous tissues, thereby narrowing the hormonally sensitive receptor area in order to prevent the growth of a hyperproliferative focus, relieve patients from pain, oedematous syndrome, aesthetic discomfort accompanying macromastia, and thus to improve the prognosis and quality of life, to obtain a good aesthetic result in the form of a natural cone-shaped breast in the immediate and remote periods.

1 cl, 10 dwg, 5 ex

Description

The invention relates to medicine, namely to plastic surgery and obstetrics-gynecology. Diseases of the mammary gland occupy a leading place in the structure of pathology of the organs of the female reproductive system. On the one hand, breast cancer (BC) is the leading localization of a malignant tumor among the female population, occupying more than 20% in the structure of oncological morbidity in Russia, on the other hand, this group of tumors makes up from 10 to 12% of all diseases of the mammary gland. Diffuse and nodular forms of benign diseases of the mammary gland represent the remaining 88-90%. The prevalence of both benign and malignant breast diseases is growing every year and, according to various authors, fibrocystic disease (FCD) is diagnosed in 60-90% of women (Kerchelaeva S.B., Smetnik A.A., Bespalov V.G. Mastopathy and prevention of breast cancer as an interdisciplinary problem // RMJ. 2016. No. 15. Pp. 1018-1025).

Until recently, DDM was a pathology of mature age, but in recent years fibrocystic mastopathy has become much younger and is observed even in puberty.

According to the American Association of Plastic Surgeons, macromastia associated with BCDD is a condition that places a significant burden on the health of patients.

To date, there are no studies to support the conclusion that conservative treatment provides effective long-term symptom relief. Instead, patients have an increased risk of obesity associated with difficulty performing physical exercises, as breast size affects posture and upper spine movement.

Clinical manifestations of mastopathy occur in 30-70% of women, and histological manifestations - in 90% of women over 30 years old, with simultaneous gynecological diseases, their frequency increases to 98%. Combined pathology of the reproductive system organs ranks among the top in the structure of morbidity among women of reproductive age. The problem of recurrence of DDMJ occupies a special place among these issues. In the works of domestic plastic surgeons dealing with the problem of breast reduction, no attention is paid to the pathomorphological diagnostics of the studied material after breast reduction. Diffuse dysplasia of the mammary gland occurs in women of different ages, and it is difficult to determine its exact prevalence in the population. It is at the stage of examination and timely diagnosis that the changes occurring in the tissues of the gland are reversible, and therefore the treatment of diffuse benign diseases of the mammary gland is today considered one of the methods that can prevent the development of breast cancer. Reducing the number of dyshormonal dysplasia of the mammary gland is a direct way to reducing the incidence of malignant neoplasms of the mammary gland.

Symptomatic macromastia or diffuse mammary dysplasia is a common condition among women worldwide, affecting various aspects of their quality of life, including physical and emotional well-being. Dyshormonal macromastia impedes daily activities, reduces productivity and quality of life. The reported incidence of histopathological abnormalities detected during reduction mammoplasty is 3-10%, the incidence of malignancy is 0.9-2.4%.

It is known that 81% of patients in the study who had abnormal histopathology had normal preoperative imaging. This study demonstrates that preoperative clinical evaluation, including mammography, is insufficient to identify women at risk of pathologically significant findings in reduction mammoplasty specimens. In this regard, special attention should be paid to the prevention of breast cancer, timely diagnosis and therapy of benign breast diseases.

Since the indications for prophylactic mastectomy in our country are strictly limited and the decision on performing prophylactic mastectomy should be made at a consultation with the participation of a physician - a medical geneticist, a surgeon/plastic surgeon, an oncologist and a medical psychologist, we are guided by the accepted clinical guidelines, but due to the fact that in the clinical guidelines for the treatment of DMDD there is no generally accepted understanding of the required duration of conservative treatment of DMDD and there are no criteria for assessing the effectiveness of treating patients with macromastia in this pathology, the proposed technique allows a differentiated approach to the choice of treatment in favor of mammary gland reduction in this category of patients. Surgical tactics in the treatment of this pathology is a preventive measure that reduces the risk of recurrence of macromastia and DMDD. This technique allows you to get excellent aesthetic results, as well as improve the reproductive health and quality of life of patients.

Surgical treatment of macromastia associated with DDM is key in the treatment of this category of patients, as it allows for the reduction of a larger volume of pathologically altered glandular tissue, a reduction in the volume of symptomatic therapy prescribed by a gynecologist-endocrinologist, or the abandonment of it. The volume of surgical intervention is determined in each case individually. Reduction of the mammary gland with subsequent reconstruction with local tissues is carried out taking into account the localization of the pathological focus.

In case of partial involvement of glandular tissue in the pathological process, the volume is restored with autologous tissues; in case of total damage to the gland, with the use of implants.

In the treatment of dyshormonal dysplasia of the mammary gland, conservative methods are the main ones, and in the case of ptosis and macromastia, only surgical correction methods are effective. For the purpose of preventing breast cancer or treating it at early stages, options for oncoplastic resections of the mammary glands are proposed.

The following works can be considered as analogues:

1. BREAST Reduction techniques and outcomes: A meta-analysis Stephen P. Daane and Bradford Rockwell Pages 293 303 Aesthetic Surgery Journal, July 1999.

2. Zakirkhodzhaev A.D. Kaprin A.D. "Oncoplastic surgery of the mammary gland" GEOTAR-Media, 2017. The article presents a technique for oncoplastic resection of the mammary gland using the inferior dermoglandular pedicle. The article describes radical resection of the mammary gland, in which the inferior glandular pedicle, including a de-epithelialized glandular-fat flap with a nipple-areolar complex, is mobilized to restore the lost volume. Indications and contraindications for this surgical intervention are described. Two clinical examples are given with a description of the surgical options. To achieve good cosmetic results, surgery is performed on the contralateral mammary gland to achieve symmetry.

Criticism of analogues

The technology for treating fibrocystic disease (FCD) remains sectoral resection of the mammary gland (MG), which consists of removing a MG sector containing a pathological lesion or formation. The disadvantages of this method are trauma with the development of hematoma in 2-10% of cases, purulent-infectious complications up to 17%, ligature fistula 3% and up to 50% - aesthetic defects in the remote period.

Radical methods include prophylactic skin-preserving mastectomy, the disadvantages of which are organ loss, high cost of subsequent rehabilitation and aesthetic defect.

In cases of macromastia and ptosis of the mammary gland, surgical correction methods such as reduction mammoplasty and mastopexy have been proposed.

Prototype

As a prototype, we took the method according to patent No. 2750272 "Method of reduction mammoplasty in gigantomastia". The prototype method consists of reducing the size of the mammary gland by removing part of the mammary gland while preserving the nipple-areolar complex.

Criticism of the prototype

The known prototype method does not take into account that macromastia and gigantomastia are accompanied by benign dysplasia of the mammary gland or fibrocystic disease affecting various parts of the mammary gland, and also, in the prototype method there is a high risk of deformation of the mammary gland in the late period in the form of ptosis, and therefore an aesthetic defect.

Purpose of the invention

The aim of the proposed invention is to increase the effectiveness of treatment of macromastia associated with benign breast dysplasia or fibrocystic disease, and to achieve a stable therapeutic and aesthetic result.

The essence of the invention

The essence of the invention is illustrated in

Fig. 1 pos. 1 - marking lines of the planned volume of the mammary gland;

Fig. 2 pos. 2 - Areas of skin de-epidermization above the cut flap;

Fig. 3 pos. 3 - diagram of flap cutting, pos. 3. Intraoperative view;

Fig. 4. pos. 4 - diagram of bed formation, pos. 4 Intraoperative view;

Fig. 5. pos. 5 - Fixation of the free edge of the inferior glandular pedicle to the fascia of the pectoralis major muscle at the level of the 2nd rib;

Fig. 6. pos. 6 - Formation of an autoimplant;

Fig. 7. Pos. 7. Scheme of covering the autoimplant. Fig. 7 pos. 7. - intraoperative view of covering the implant;

Fig. 8. pos. 8. diagram of applying modeling sutures. Fig. 8 pos. 8 - intraoperative view of applying modeling sutures;

Fig. 9 - view before surgery and one year after surgery;

Fig. 10 - view 3 years after surgery.

The essence of the invention is as follows:

Before the operation, ultrasound and mammography are performed, and the degree and prevalence of dysplasia of the glandular component are assessed based on the degree of compaction of the mammary gland. Having received the necessary information on the prevalence of glandular component dysplasia according to the degree of compaction of the mammary gland, special marking lines of the planned volume of the mammary gland are applied (Fig. 1 pos. 1 - marking lines of the planned volume of the mammary gland), a skin incision is made, the cut flap is de-epidermized (Fig. 2 pos. 2 - areas of skin de-epidermization above the cut flap), a nourishing dermoglandular pedicle is formed with lateral triangular-shaped petal flaps (Fig. 3 pos. 3 - diagram of flap cutting), then areas of cystic or fibrously altered tissue are resected with a radio knife, a bed is formed in the projection of the 2-3 intercostal spaces (Fig. 4 pos. 4 - diagram of bed formation), where the reconstructed gland will be located, and the free edge of the formed glandular pedicle is fixed to the fascia of the pectoralis major muscle (PCM) at the level of the 2nd rib with non-absorbable sutures (Fig. 5. pos. 5 - Fixation of the free edge of the lower glandular pedicle to the fascia of the pectoralis major muscle at the level of the 2nd rib). The next step is to form an autoimplant by folding in the lateral petals of the dermoglandular pedicle, fixing them to the pectoral fascia along the lower edge, and to the pedicle itself in the upper part (Fig. 6. pos. 6. Formation of the autoimplant). Then the skin and fat flaps are mobilized and cover the formed autoimplant (Fig. 7. pos. 7. diagram of covering the autoimplant). Reinforcing sutures are applied between the superficial fascia and the fascia of the pectoralis major muscle outward from the formed autoimplant (Fig. 8. pos. 8. diagram of applying modeling sutures). The state of the microcirculatory blood flow is assessed using the LAKK-OP laser analyzer. Layered sutures on the wound with absorbable threads. Fig. 9 shows the view before the operation and one year after the operation, and Fig. 10 shows the view three years after the operation.

The method is carried out as follows:

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the zones of the greatest changes in the density of the breast tissue, plan the future volume of the breast taking into account the removed volume of glandular tissue, the height and weight of the patient. Then we perform marking along certain lines to plan the future volume and position of the breast, as well as the nipple-areolar complex with a diameter of 4.5 cm, at the level of the submammary fold at a distance of 20 +/- 2 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines (Fig. 2, pos. 2). Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide (Fig. 3 pos. 3). Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal space (Fig. 4 pos. 4). Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PCM) at the level of the 2nd rib with non-absorbable sutures (Fig. 5 pos. 5). To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland (Fig. 6 pos. 6). At the next stage, we mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland (Fig. 7 pos. 7). Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major to the outside of the formed dermoglandular autoimplant (Fig. 8 pos. 8). Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers. Clinical examples of the method:

1) Example 1

Patient I., 44 years old, was admitted with complaints of large breast volume, pain and discomfort in the breasts, back pain and fatigue, aesthetic discomfort and deterioration in quality of life.

Diagnosis: fibrocystic mastopathy, adenofibrosis of the mammary glands, macromastia, mastoptosis stage 3.

Concomitant diseases: uterine fibroids, endometriosis.

Histological conclusion:

History: long-term.

The operation was performed using the proposed method.

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the areas of greatest changes, and plan the volume of resection. Then we mark along certain lines to plan the future volume and position of the mammary gland, at the level of the submammary fold at a distance of 20 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines. Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide. Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces. Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures. To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland. The next step is to mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland. Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major outside the formed dermoglandular autoimplant. Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers.

The postoperative period was smooth, the sutures healed by primary intention, discharged on the 5th day. The results of the operation according to the proposed method confirmed the positive effect set in the objectives of the invention.

2) Example 2

Patient K.I.P., 35 years old.

BIRADS 3

BMI 32 kg/ ^m2 .

Associated pathology: adenomyosis, hypothyroidism.

Reduction of mammary glands, correction of body weight with the drug saxenda, L-thyroxine were performed. The operation was performed according to the proposed method.

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the areas of greatest changes, and plan the volume of resection. Then we mark along certain lines to plan the future volume and position of the mammary gland, at the level of the submammary fold at a distance of 22 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines. Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide. Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces. Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures. To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland. The next step is to mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland. Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major outside the formed dermoglandular autoimplant. Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers.

The postoperative period was smooth, the sutures healed by primary intention, discharged on the 5th day. The results of the operation according to the proposed method confirmed the positive effect set in the objectives of the invention.

Result after 3 months: weight loss of 9 kg, reduction according to the BIRADS scale 2.

3) Example 3

Patient T.O.I., 33 years old, BMI 25 kg/ ^m2 .

BIRADS 3

Associated pathology: adenomyosis.

The operation was performed using the proposed method.

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the areas of greatest changes, and plan the volume of resection. Then we mark along certain lines to plan the future volume and position of the mammary gland, at the level of the submammary fold at a distance of 20 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines. Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide. Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces. Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures. To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland. The next step is to mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland. Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major outside the formed dermoglandular autoimplant. Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers.

The postoperative period was smooth, the sutures healed by primary intention, discharged on the 5th day. The results of the operation according to the proposed method confirmed the positive effect set in the objectives of the invention.

4 months after the operation, ultrasound data showed a decrease in the density of glandular tissue BIRADS 2

Example 4

Patient Z.I.T.

BMI 28 kg/ ^m2 .

BIRADS 3

Concomitant pathology: uterine fibroids, endometriosis.

Reduction of mammary glands and correction of hormonal disorders were performed by a gynecologist-endocrinologist.

The operation was performed using the proposed method.

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the areas of greatest changes, and plan the volume of resection. Then we mark along certain lines to plan the future volume and position of the mammary gland, at the level of the submammary fold at a distance of 20 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines. Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide. Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces. Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures. To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland. The next step is to mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland. Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major outside the formed dermoglandular autoimplant. Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers.

The postoperative period was smooth, the sutures healed by primary intention, discharged on the 5th day. The results of the operation according to the proposed method confirmed the positive effect set in the objectives of the invention.

5 months after surgery

BIRADS 2, decrease in BMI to 25 kg/ ^m2 . Ultrasound shows a decrease in the clinical picture of endometriosis, absence of its clinical manifestations.

Example 5

Patient M.M.T. 33 years old

BMI 25 kg/ ^m2 .

BIRADS 3

Concomitant pathology: endometriosis, pituitary adenoma (prolactinoma), primary infertility, menstrual irregularities. The operation was performed using the proposed method.

Using ultrasound and mammography, we determine the structure and density of the breast tissue with a detailed description of the areas of greatest changes, and plan the volume of resection. Then we mark along certain lines to plan the future volume and position of the mammary gland, at the level of the submammary fold at a distance of 20 cm from the jugular notch at the intersection with the midclavicular line. The distance from the submammary fold to the edge of the areola does not exceed 7 cm. Then we perform deepidermization of the lower-medial dermoglandular pedicle along the marking lines. Next, using a radio knife, perpendicular to the surface of the chest, we cross the breast tissue to the fascia of the pectoralis major muscle and form the lower feeding glandular pedicle with lateral triangular flaps, on a base 8 cm wide. Using a radio knife, we remove areas of fibrous and cystic altered breast tissue, form a bed for the moving free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces. Next, we fix the free edge of the glandular pedicle to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures. To form the shape of the future mammary gland, we direct the lateral triangular petals of the flap of the formed dermoglandular pedicle upward and suture the upper edges to the free edge of the glandular pedicle, the lower edges to the fascia. As a result, we obtain a formed dermoglandular autoimplant, maximally close to the conical shape of the future mammary gland. The next step is to mobilize the skin and fat flaps laterally and medially to cover the formed dermoglandular autoimplant, moving them relative to the chest wall taking into account the new shape and size of the mammary gland. Next, we apply reinforcing sutures between the superficial fascia and the fascia of the pectoralis major outside the formed dermoglandular autoimplant. Finally, we apply layer-by-layer sutures to the wound with absorbable suture material. Cosmetic sutures on the skin and aseptic stickers.

The postoperative period was smooth, the sutures healed by primary intention, discharged on the 5th day. The results of the operation according to the proposed method confirmed the positive effect set in the objectives of the invention.

After the operation, after 6 months, the body mass index decreased to 22 kg/m2. Improvement according to the BIRADS 2 scale.

Normalization of the menstrual cycle.

The technical result obtained from the use of the invention.

The method allows to reduce the volume of the mammary gland, remove fibrocystic tissues, fix a new position of the mammary gland during the operation, create an aesthetic cone-shaped mammary gland corresponding to the height and weight, preserve blood supply and innervation. The use of the lower dermoglandular pedicle and cutting out a flap with lateral triangular petals, fixing them to the fascia of the pectoralis major muscle allow to form a dermoglandular autoimplant of a conical shape, providing an aesthetic long-term result, reducing the risk of necrosis of the wound edges and loss of sensitivity of the SAC. Thus, there is a decrease in the size of the mammary gland, modeling of a new shape and fixation for the stability of the result. The therapeutic effect is provided by a decrease in the volume of hyperplastic tissues, and as a consequence, the area of receptor zones, pain sensations and an improvement in the quality of life. The method allows to remove areas of fibrously altered tissues, thereby narrowing the receptor area sensitive to hormonal effects in order to prevent the growth of a hyperproliferative focus, to relieve patients from pain, edema syndrome, aesthetic discomfort accompanying macromastia with DDM, and thereby to improve the prognosis and quality of life, to obtain a good aesthetic result in the form of a natural cone-shaped breast in the near and distant periods (Fig. 9, Fig. 10).

Information taken into account:

1. “Method of reduction mammoplasty for giantomastia” patent No. 2750272 – prototype.

2. BREAST Reduction techniques and outcomes: A meta-analysis Stephen P.Daane and Bradford Rockwell Pages 293-303 Aesthetic Surgery Journal, July 1999.

3. Zakirkhodzhaev A.D. Kaprin A.D. “Oncoplastic surgery of the mammary gland” GEOTAR-Media. 2017.

4. Pshenisnov K.P. Sazhienko V.V. Reconstruction of the mammary gland after oncoplastic operations. - Electronic publication, 2008.

https://booksmed.info/hirurgiya/2901-rekonstrukciya-molochnoy-zhelezy-posle-onkologicheskih-operaciy-pshenisnov.html (PDF).

5. Stephen P.Daane VS W.Breadford Rockwe MD BREAST Reduction techniques and outcomes: A meta-analysis Aesthetic Surgery Journal, July 1999 Pages 293-303.

Claims (1)

A method for surgical treatment of macromastia associated with benign dysplasia of the mammary gland, consisting in performing reduction mammoplasty, characterized in that before the operation, an ultrasound examination of the mammary gland and mammography are performed, then incisions are made along the marking lines, then de-epidermization of the dermoglandular pedicle is performed along the marking lines, then the tissue of the mammary gland is crossed to the fascia of the pectoralis major muscle and the lower feeding glandular pedicle with lateral triangular flaps is formed, on a base 8 cm wide, areas of fibrous and cystic altered tissues of the mammary gland are removed, a bed is formed for the displaced free edge of the glandular pedicle in the projection of the 2-3 intercostal spaces, then the free edge of the glandular pedicle is fixed to the fascia of the pectoralis major muscle (PMG) at the level of the 2nd rib with non-absorbable sutures, the lateral triangular flaps of the formed dermoglandular pedicle are unfolded upward and the upper edges of the flap are sutured to the free edge of the glandular pedicle dermo-dermally, and the lower edges of the flap to the fascia of the BGM with a continuous suture; the skin-fat flaps are mobilized in the direction of the mammary gland, covered, and sutures are applied to the subcutaneous tissue and skin.